Capecitabine Plus Oxaliplatin Plus Bevacizumab as First-line Treatment in Elderly Patients With Metastatic Colorectal Cancer

Capecitabine, oxaliplatin and bevacizumab are well known active agents in the treatment of mCRC. The treatment of elderly patients with mCRC is an area of investigation. The role of comprehensive geriatric assessment in treatment efficacy and tolerance is an area of investigation.

Inclusion criteria

• Histologically or cytologically confirmed adenocarcinoma of the colon or rectum
• Stage IV
• Existence of two-dimensional measurable disease. The measurable disease should not have been irradiated.
• Absence or irradiated and stable central nervous system metastatic disease.
• Life expectancy of more than 3 months.
• Age ≥ 70 years.
• Performance status (WHO) ≤ 2.
• Adequate bone marrow function (Absolute neutrophil count >1000/mm3, Platelet count >100000/mm3, Hemoglobin >9gr/mm3).
• Adequate liver (Bilirubin <1.5 times upper limit of normal and SGOT/SGPT <2 times upper limit of normal).
• Creatinine clearance (Cockcroft-Gault formula) >30ml/min.
• No other invasive malignancy within the past 5 years except nonmelanoma skin cancer.
• Presence of a reliable care giver.
• Informed consent.

Exclusion criteria

• Prior chemotherapy for metastatic disease.
• History of thromboembolic disease or myocardial infraction within the last 6 months.
• Peripheral neuropathy ≥ grade 2.
• Bowel obstruction or chronic diarrhea.
• Psychiatric illness or social situation that would preclude study compliance.
• Other concurrent uncontrolled illness.
• Other concurrent investigational agents.