First-line treatment with modified FOLFOXIRI plus bevacizumab in patients with locally advanced colorectal cancer

Introduction: The combination regimen of fluorouracil, folinate, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevaci- zumab (Bmab) is recommended as the first-line treatment for patients with mutant RAS/BRAF or patients with wild RAS/ BRAF right-side located, according to the 2019 colorectal cancer guidelines of the Japanese Society of Cancer for Colon and Rectum. However, little is known the practical results for Japanese patients. Patients: Five cases with FOLFOXIRI + Bmab therapy as first-line for locally advanced colorectal cancer (CRC) with or without metastasis in our department from August 2018 were analyzed. Results: A median age was 71 years old including 4 male and 1 female. The location of cancer was as right-side colon in 1 case, left-side colon in 3 cases, and rectum in 1 case. Three cases had KRAS mutation. One case of BRAF mutation was found. Bypass or colostomy was performed in all patients prior to chemotherapy. A median number of 10 (3–16) chemo- therapy courses were administered, and the best response was partial response (PR) in four cases and stable disease (SD) in one case. Considering primary tumor, four cases achieved primary site resection and one case was radically resected as Cur B resection. Three patients experienced grade 3 toxicity and then the treatment dose was reduced. Conclusion: Our experienced 5 cases of locally advanced CRC treated with modified FOLFOXIRI + Bmab as fist-line therapy demonstrated that quite good tumor shrinkage was obtained in a quite short period of therapy even with quite high incidence of severe toxicities.