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This combination regimen, evaluated in the Phase 2 AXOAXI trial (NCT00541021), consists of the anti-VEGF monoclonal antibody bevacizumab administered alongside alternating cycles of two chemotherapy backbones: XELOX (capecitabine and oxaliplatin) and XELIRI (capecitabine and irinotecan). Developed under the leadership of Pia Osterlund, the regimen is designed for the first-line treatment of metastatic colorectal cancer. The strategy involves three cycles of XELOX plus bevacizumab alternating with three cycles of XELIRI plus bevacizumab, aiming to maintain continuous inhibition of angiogenesis while rotating cytotoxic agents to mitigate cumulative toxicity and delay the onset of drug resistance. Bevacizumab targets vascular endothelial growth factor A (VEGF-A) to inhibit tumor angiogenesis, while the chemotherapy components provide broad cytotoxic activity through DNA cross-linking, topoisomerase I inhibition, and thymidylate synthase inhibition.
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