capecitabine + oxaliplatin + irinotecan + bevacizumab

A quadruple chemotherapy regimen combining three cytotoxic agents (capecitabine, oxaliplatin, and irinotecan) with the targeted anti-angiogenic monoclonal antibody bevacizumab. This combination targets multiple cancer pathways simultaneously through DNA synthesis inhibition (capecitabine), DNA crosslinking (oxaliplatin), topoisomerase I inhibition (irinotecan), and VEGF-mediated angiogenesis blockade (bevacizumab). ## Mechanism of Action This regimen combines four distinct agents with complementary mechanisms: 1. **Capecitabine**: An oral fluoropyrimidine that converts to 5-fluorouracil in tumor tissue, inhibiting DNA synthesis and cell division. 2. **Oxaliplatin**: A platinum-based compound that forms DNA adducts, preventing DNA replication and transcription. 3. **Irinotecan**: A topoisomerase I inhibitor that prevents DNA unwinding and replication. 4. **Bevacizumab**: A monoclonal antibody that targets vascular endothelial growth factor (VEGF), inhibiting angiogenesis and tumor blood vessel formation. ## Clinical Applications This quadruple regimen has been studied in clinical trials for: - First-line treatment of metastatic colorectal cancer - Treatment of gastrointestinal neuroendocrine carcinoma (NEC) ## Efficacy Data Clinical studies have shown promising results with this combination: - In metastatic colorectal cancer, the regimen has demonstrated median progression-free survival of 10.4-16 months and median overall survival of 24.4-29 months. - For gastrointestinal neuroendocrine carcinoma, the combination showed an overall response rate of 47.4% and median progression-free survival of 13 months. ## Toxicity Profile The combination has significant toxicity, with grade 3/4 adverse events including: - Diarrhea (16-36%) - Vomiting (21%) - Fatigue (17%) - Hematologic toxicities Due to these toxicities, modified dosing regimens have been explored to improve tolerability while maintaining efficacy.

Brand names

EloxatinCamptosarXelodaAvastin

Other names

CAPOXIRI-BEVCAPOXIRI+BEV