Capecitabine with or without bevacizumab as maintenance therapy in metastatic colorectal cancer: a real-world retrospective study in Vietnamese patients.

[OBJECTIVES] This study evaluated the effectiveness and safety of maintenance therapy with capecitabine ± bevacizumab in Vietnamese patients with mCRC after disease control following first-line chemotherapy.

[METHODS] A retrospective cohort study was conducted at Vietnam National Cancer Hospital (March - May 2025). Eligible patients had mCRC, achieved response or stable disease after CAPOX plus bevacizumab, and received maintenance capecitabine alone or with bevacizumab. The primary endpoint was progression-free survival (PFS). Safety was assessed using CTCAE v5.0. Kaplan - Meier and Cox regression analyses were performed.

[RESULTS] Among 148 patients, 54 (36.5%) received capecitabine alone and 94 (63.5%) received bevacizumab - capecitabine. Baseline characteristics were balanced. Median PFS was 9.9 months (95% CI: 7.5-12.4) with bevacizumab - capecitabine vs. 5.8 months (95% CI: 4.3-7.4) with capecitabine alone (HR = 0.477,  = 0.001). Multivariable analysis showed that bevacizumab use (HR = 0.384,  = 0.001), achieving CR/PR after induction (HR = 0.416,  = 0.003), and absence of peritoneal metastases (HR = 1.758,  = 0.046) were independently associated with improved PFS. Both regimens were well tolerated, with no treatment-related deaths. The most common toxicity was hand - foot syndrome (27.7% vs. 25.9%). Hypertension and rare events (GI perforation, thrombosis) occurred only in the bevacizumab group but were infrequent. Grade 3-4 adverse events were uncommon and manageable.

[CONCLUSIONS] In this first real-world study from Vietnam, maintenance therapy with bevacizumab plus capecitabine significantly improved PFS compared to capecitabine alone, with acceptable safety. These findings support the use of biologic-based maintenance strategies in appropriate patients and provide valuable evidence for guiding mCRC treatment in resource-constrained settings.