Antiangiogenesis therapy in second line metastatic colorectal cancer: similar but different.

Recent updates in the second-line treatment of patients with metastatic colorectal cancer (mCRC) have indicated the benefit of adding aflibercept (plus FOLFIRI) after an oxaliplatin-containing regimen (with or without bevacizumab) or a bevacizumab-containing regimen after progression on a different bevacizumab-containing regimen. This has led some oncologists to compare the trials and equate the drugs, with the assumption that they confer equal efficacy, but the background of this must be adequately assessed before reaching this conclusion. In fact, the publication of these trial results has left oncologists with much to consider for their mCRC patients who will eventually progress on a first-line chemotherapy/bevacizumab regimen. The author comments on this issue and emphasizes the need for additional research into antiangiogenic biomarkers to identify patients who are likely to respond to one drug more than another.