Bevacizumab + Triplet Treatment for Untreated With Chemotherapy Metastatic Colorectal Cancer

Inclusion criteria

• Histologically confirmed adenocarcinoma of the colon or rectum.
• Unresectable or recurrent colorectal cancer patient.
• One or more measurable lesion in RECIST ver.1.1 criteria.
• No prior chemotherapy, immunotherapy, and radiotherapy.
• Life expectancy at least 3 months.
• Patients who harbor UGT1A1*1/*1, *1/*6 or *1/*28.
• The Eastern Cooperative Oncology Group (ECOG) performance status of =<1.
• Vital organ functions (listed below) are preserved within 14 days prior to entry.

White blood cell count (WBC): >= 3,000 per cubic millimeter Neu: >= 1,500 per cubic millimeter Platelet count (PLT): >= 100,000 per cubic millimeter Aspartate aminotransferase (AST/GOT) and alanine aminotransferase (ALT/GPT): <= 100 IU/L, <= 150 IU/L in cases with liver metastasis T-bil: <= 1.5 mg/dL Serum creatinine: <= 1.50 mg/dL Proteinuria: <= 1+ Prothrombin time-international normalized ratio (PT-INR): < 1.5

• Written informed consent.

Exclusion criteria

• Vermiform appendix cancer and anal canal cancer.
• Administration of blood products/ granulocyte-colony stimulating factor (G-CSF), and blood transfusion within 14 days prior to enrollment.
• Synchronous multiple malignancy or metachronous multiple malignancy less than 5 years disease free interval.
• Hepatitis B virus antigen (HBs-Ag)(+), or hepatitis C virus antibody (HCV-Ab)(+).
• History of severe allergy.
• Sensory alteration or paresthesia interfering with function.
• Prior radiotherapy for ilium and abdomen.
• Infectious disease.
• Uncontrolled diarrhea.
• Ileus or bowel obstruction.
• Interstitial lung disease or pulmonary fibrosis.
• Malignant coelomic fluid required drainage.
• Administration of atazanavir sulfate.
• Heart disease to be clinically problem.
• Major surgical procedure or intestinal resection within 28 days prior to enrollment or colostomy within 14 days prior to enrollment.
• Known brain metastasis or strongly suspected of brain metastasis.
• History of a thromboembolic disease.
• Receiving anti-platelet drugs.
• Poorly controlled gastrointestinal ulcer.
• History of intestinal perforation within the past 12 months.
• Poorly controlled hypertension.
• Poorly controlled diabetes mellitus.
• Severe mental disorders.
• Women who are pregnant or nursing, men and women who wish to conceive a child or with no intention to contraception.
• Any other cases who are regarded as inadequate for study enrollment by investigators.