VASCular Impact of Angiogenic Treatment in Patients With Advanced Colorectal Cancer

Inclusion criteria

• Patient at least 18 years old,
• Patient with colorectal cancer of the adenocarcinoma type, stage IV, histologically confirmed, mutated or wild tumor RAS status (exons 2, 3 and 4 of the KRAS and NRAS genes), mutated or wild BRAF status, naive in antineoplastic treatment
• Patient eligible to start systemic carcinological treatment including bevacizumab in combination with chemotherapy based on IV fluoropyrimidine,
• General condition WHO grade less than or equal to 3,
• Life expectancy greater than 4 months,
• Patient who has read and understood the information letter and signed the consent form,
• Patient affiliated to a social security scheme,
• Effective contraception (see WHO definition) in women of childbearing age (negative pregnancy test). For postmenopausal women, a confirmatory diagnosis should be obtained (amenorrhea not medically induced for at least 12 months before the inclusion visit).

Exclusion criteria

• Previous exposure to anti-VEGF,
• Exposure to treatment for metastatic disease in the 12 months prior to inclusion,
• Other histologically proven neoplasia not considered in complete remission or considered in complete remission for less than two years,
• Bilateral carotid breath,
• Absence of peripheral pulse of the two upper limbs,
• Contraindication to AVASTIN 25 mg / ml concentrate for solution for infusion:

• Hypersensitivity to the active substance or to any of the excipients,
• Hypersensitivity to Chinese hamster ovarian cell products or other human or humanized recombinant antibodies,
• Patients:

• having undergone a major surgical intervention in the 28 days preceding the inclusion or as long as the surgical wound is not completely healed,
• Unhealed ulcer or wound,
• having uncontrolled pre-existing hypertension (PAS> or = 170 mm Hg after three repeated measurements at rest),
• having a history of arterial thromboembolism (transient ischemic attack (TIA), cardiovascular accident (stroke) or recent (<6 months) and / or symptomatic myocardial infarction (MI)
• having had an invasive dental procedure in the 28 days preceding inclusion,
• with known proteinuria> 2g / 24h or in whom proteinuria> 2g / 24h is discovered in the case of a positive urine strip 3+ for proteins (excluding urinary tract infection),
• on aspirin> 325 mg / d,
• with a colonic prosthesis in place,
• Systemic treatment with anti-EGFR monoclonal antibodies,
• Presence or history of lymphedema of the bilateral upper limbs,
• Patient with poor understanding of spoken or written French,
• Patient deprived of liberty by an administrative or judicial decision or patient placed under the protection of justice, under guardianship or curatorship,
• Pregnant or lactating woman or wishing to breastfeed within 6 months after the last administration of the treatment,
• Patient participating in another drug trial / having participated in another drug trial within 30 days of inclusion,
• History of illness or psychological or sensory abnormality likely to prevent the subject from fully understanding the conditions required for his participation