Aflibercept plus FOLFIRI as second-line therapy in metastatic colorectal cancer (mCRC) during pandemic COVID-19: a real-world experience

: The use of Aflibercept plus Folfiri represents the second-line chemotherapy in patients with metastatic colorectal cancer (mCRC) previously treated with Oxaliplatin. The outbreak of COVID-19 upset the standardized procedure of routinary access to the hospital with a lot of difficulty in administering chemotherapy. For this reason, we conducted this retrospective study on 78 enrolled patients who were diagnosed with mCRC, through the pandemic period. Primary endpoints were quality of life (QoL), progression-free survival (PFS) and overall response rate (ORR) in two patient groups treated before and after the onset of COVID-19, group A and group B, respectively. Secondary endpoints were tolerability profile, prognostic factors and carcinoembryonic antigen (CEA) reduction. The median age in all patients was 58 years old, and the median PFS was 6.2 months (95% CI: 5.1-7.2). A significant correlation was observed between decreased CEA levels and PFS with a P value of 0.63 (P = 0.009), which led to consequent improvement of QoL. The treatment was well tolerated, with good disease control and a manageable toxicity profile. Our survival analysis shows a non-significant difference in PFS in the two groups of patients treated before and after COVID-19 (6.1 versus 6.2 months). Furthermore, our analysis suggests left-side tumor site and wild-type RAS/BRAF status as potential prognostic factors for PFS and ORR. The results showed therapeutic benefits of AFL plus Folfiri as second-line therapy in mCRC patients previously treated with Oxaliplatin. The use of AFL plus Folfiri showed efficacy and safety, although the COVID-19 pandemic has affected the management of patients’ care.