# TRIBE2

Source: https://onco.cc/trials/tribe2/  
OnCo record `tribe2` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Testing the triplet as a whole strategy rather than one line of treatment. Using all three drugs first, and again after progression, worked better than saving them.

## Summary

TRIBE2 randomised 679 patients with unresectable, previously untreated metastatic colorectal cancer to upfront FOLFOXIRI plus bevacizumab with reintroduction of the same regimen after progression, or to mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab. The primary endpoint, progression-free survival 2 (time to progression on any second-line treatment), was 19.2 against 16.4 months (hazard ratio 0.74, 95% CI 0.63 to 0.88, p=0.0005). Grade 3 or 4 diarrhoea (17 against 5 percent) and neutropenia (50 against 21 percent) were more common with the triplet during first-line treatment, and eight treatment-related deaths occurred in the experimental group against four in the control group. The trial answered the objection to TRIBE, that the triplet merely front-loads drugs that would have been used anyway.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-24
- Registry id: NCT02339116
- Phase: 3
- Setting: Untreated metastatic colorectal cancer: upfront FOLFOXIRI plus bevacizumab with reintroduction after progression, against sequential mFOLFOX6 then FOLFIRI, each with bevacizumab
- Sponsor: Gruppo Oncologico del Nord-Ovest
- Enrolled: 679
- Result: Progression-free survival 2 of 19.2 against 16.4 months (hazard ratio 0.74).
- Outcomes: Progression-free survival 2: Upfront FOLFOXIRI plus bevacizumab 19.2 months vs Sequential doublets plus bevacizumab 16.4 months, HR 0.74

## Sources

- ClinicalTrials.gov NCT02339116: https://clinicaltrials.gov/study/NCT02339116
- TRIBE2: upfront FOLFOXIRI plus bevacizumab and reintroduction after progression (Lancet Oncology 2020): https://doi.org/10.1016/S1470-2045(19)30862-9

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- technologies: [Anti-angiogenic therapy](https://onco.cc/technologies/antiangiogenic/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/)
- targets: [VEGF / VEGFR](https://onco.cc/targets/vegf/)
- drugs: [Bevacizumab](https://onco.cc/drugs/bevacizumab/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan)](https://onco.cc/drugs/folfoxiri/)
- trials: [TRIBE](https://onco.cc/trials/tribe/)

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