FOLFOXIRI and Bevacizumab for Metastatic Colorectal Cancer

To the Editor: In their article on the Triplet plus Bevacizumab (TRIBE) study, Loupakis et al. (Oct. 23 issue) 1 conclude that chemotherapy with fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus bevacizumab improved the outcome of patients with metastatic colorectal cancer, as compared with a control group receiving fluorouracil, leucovorin, and irinotecan (FOLFIRI) plus bevacizumab. However, I question the basis for this conclusion. First, although the median duration of progression-free survival was 12.1 months in the FOLFOXIRI group, as compared with 9.7 months in the control group, there was no significant improvement in overall survival with FOLFOXIRI. Second, FOLFOXIRI caused significantly . . .