Optimal Use of FOLFOXIRI Plus Bevacizumab as First-Line Systemic Treatment in Metastatic Colorectal Cancer

Purpose of Review Colorectal cancer is the second leading cause of cancer-related deaths in the USA with more than half of diagnosed patients developing metastatic disease. The mainstay of treatment for metastatic disease is chemotherapy, and upfront treatment has generally consisted of a two-drug chemotherapy combination (FOLFOX or FOLFIRI) plus a biologic agent. In this review, we explore the emerging role of the three-drug chemotherapy combination FOLFOXIRI plus bevacizumab as first-line treatment in metastatic colorectal cancer. Recent Findings Randomized trials evaluating the efficacy of FOLFOXIRI plus bevacizumab have shown improvement in objective response rate, overall survival, and resection rate when compared to previous standard therapy. However, this comes with added toxicity, which can be one of the main barriers to its widespread implementation. FOLFOXIRI plus bevacizumab is an effective therapy in carefully selected patients; however, more clinical trials investigating the regimen's role in colorectal cancer remain a significant need.