A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial of Pegfilgrastim in Patients Receiving First-Line FOLFOX/Bevacizumab or FOLFIRI/Bevacizumab for Locally Advanced or Metastatic Colorectal Cancer: Final Results of the Pegfilgrastim and Anti-VEGF Evaluation Study (PAVES)

• Published in: Clinical colorectal cancer Vol. 16; no. 2; pp. 103 - 114.e3
• Main Authors: Pinter, Tamás, Klippel, Zandra, Cesas, Alvydas, Croitoru, Adina, Decaestecker, Jochen, Gibbs, Peter, Hotko, Yevhen, Jassem, Jacek, Kurteva, Galina, Novotny, Jan, O'Reilly, Seamus, Salek, Tomas, Reiner, Maureen, Morrow, Phuong Khanh, Choi, Mi Rim, Whittaker, Sadie, Blanke, Charles
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2017
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Bevacizumab - administration & dosage; Camptothecin - administration & dosage; Camptothecin - adverse effects; Camptothecin - analogs & derivatives; Chemotherapy; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Disease-Free Survival; Double-Blind Method; Febrile neutropenia; Febrile Neutropenia - chemically induced; Febrile Neutropenia - epidemiology; Febrile Neutropenia - prevention & control; Female; Filgrastim - administration & dosage; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Follow-Up Studies; Humans; Incidence; Leucovorin - administration & dosage; Leucovorin - adverse effects; Male; Middle Aged; Neoplasm Metastasis; Objective response rate; Organoplatinum Compounds - administration & dosage; Organoplatinum Compounds - adverse effects; Overall survival; Polyethylene Glycols - administration & dosage; Progression-free survival; Proportional Hazards Models; Prospective Studies; Survival Rate; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Young Adult; Objective response rate; Chemotherapy; Overall survival; Progression-free survival; Febrile neutropenia
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2016.08.008

In a phase III, double-blind trial, 845 patients with advanced colorectal cancer receiving bevacizumab plus first-line chemotherapy (FOLFOX [leucovorin), 5-fluorouracil, oxaliplatin] or FOLFIRI [leucovorin, 5-fluorouracil, irinotecan]) were randomized to pegfilgrastim versus placebo. Pegfilgrastim significantly reduced grade 3/4 febrile neutropenia, with no differences in tumor response rates, survival outcomes, or nonhematologic toxicities observed between the 2 arms.
Pegfilgrastim's role in reducing the risk of febrile neutropenia (FN) in patients with colorectal cancer (CRC) receiving chemotherapy plus bevacizumab was not previously evaluated in a prospective study. The present phase III, double-blind trial evaluated the efficacy of pegfilgrastim versus placebo in reducing the incidence of grade 3/4 FN in patients with advanced CRC receiving bevacizumab combined with first-line chemotherapy (FOLFOX [leucovorin, 5-fluorouracil, oxaliplatin] or FOLFIRI [leucovorin, 5-fluorouracil, irinotecan]).
Patients aged ≥ 18 years with locally advanced or metastatic CRC were randomized 1:1 to placebo or 6 mg of pegfilgrastim ∼24 hours after receiving chemotherapy plus bevacizumab every 14 days. The study treatment period included 4 cycles, but patients could continue treatment for ≤ 60 months. The primary endpoint was incidence of grade 3/4 FN in the first 4 cycles. The secondary endpoints included the objective response rate (ORR), overall survival, and progression-free survival, analyzed at the end of the long-term follow-up period.
A total of 845 patients were randomized from November 2009 to January 2012 (422, pegfilgrastim; 423, placebo). Pegfilgrastim significantly reduced the incidence of grade 3/4 FN in the first 4 treatment cycles (pegfilgrastim, 2.4%; 95% confidence interval [CI], 1.1%-4.3%; placebo, 5.7%; 95% CI, 3.7%-8.3%; odds ratio [OR], 0.41; P = .014). No significant differences were observed between the 2 arms in ORR (OR, 1.15; P = .330), overall survival (hazard ratio, 0.94; P = .440), and progression-free survival (hazard ratio, 0.93; P = .300).
Pegfilgrastim reduced the FN incidence in patients with advanced CRC receiving chemotherapy and bevacizumab. Administration of pegfilgrastim was tolerable and did not negatively affect the tumor response or survival in this patient population.