Using bevacizumab with different chemotherapeutic regimens in metastatic colorectal cancer: balancing utility with low toxicity

The addition of bevacizumab to currently available treatment options for metastatic colorectal cancer has changed the traditional chemotherapy-based paradigm. In this review we cover published clinical trials pertaining to the toxicity and efficacy of bevacizumab for metastatic colorectal cancer. Several randomized trials have studied combinations of irinotecan, oxaliplatin, 5-fluorouracil or capecitabine with bevacizumab. Efficacy in terms of progression-free survival and overall survival has been improved to varying degrees with the addition of bevacizumab. Bevacizumab's distinctive toxicity profile has been well demonstrated in these trials, and has been shown to be manageable. However, certain patient groups, such as the elderly, may require particular toxicity considerations with bevacizumab. The optimal timing, dose and duration of bevacizumab-containing therapy have yet to be fully determined. Further randomized data, particularly for patients with potentially resectable liver metastases, are required in order to fully define the role of bevacizumab in the increasingly complex management paradigm for this disease.