Sintilimab + Bevacizumab + Oxaliplatin + Capecitabine

The combination of sintilimab plus bevacizumab, oxaliplatin, and capecitabine (sometimes referred to as BBCAPX) is a treatment regimen that has been studied primarily for metastatic colorectal cancer (mCRC), particularly in patients with RAS-mutant and microsatellite stable (MSS) disease. This combination incorporates immunotherapy (sintilimab), anti-angiogenesis therapy (bevacizumab), and chemotherapy (oxaliplatin and capecitabine) to create a multi-targeted approach. ## Clinical Evidence Several phase II clinical trials have evaluated this combination: - The BBCAPX-II trial demonstrated promising efficacy with an objective response rate (ORR) of 72.7% to 84% and a disease control rate (DCR) of 100% in RAS-mutant, MSS mCRC patients[1][3][4]. - Median progression-free survival (PFS) was reported as 12.9 to 17.9 months across different studies[2][4]. - Patients with liver metastases showed particularly good responses, with ORR as high as 93.3% in some studies[3][4]. ## Mechanism of Action This combination works through multiple mechanisms: - **Sintilimab**: A PD-1 inhibitor that enhances T-cell immune responses against tumor cells - **Bevacizumab**: An anti-VEGF antibody that inhibits angiogenesis - **Oxaliplatin and Capecitabine**: Chemotherapy agents that directly kill cancer cells and may enhance immunotherapy response by increasing tumor antigen presentation The rationale behind this combination is that chemotherapy and anti-angiogenesis therapy may promote immunotherapy response in patients who would otherwise have low response rates to immunotherapy alone, such as those with MSS colorectal cancer[1][3]. ## Safety Profile The combination has shown a manageable safety profile in clinical trials. Most immune-related adverse events were grades 1-2, though some patients discontinued immunotherapy due to immune-related adverse events[2]. No treatment-related deaths were reported in the studies reviewed[2]. ## Development Status This combination is currently being evaluated in phase III clinical trials (NCT05171660) to further analyze its effects, safety, and prognostic biomarkers[4]. The promising results from phase II trials have led to continued investigation of this regimen as a potential first-line treatment option for RAS-mutant, MSS mCRC patients.

Brand names

TyvytAvastinXeloda

Other names

XELOXCAPOX