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Giving all three chemotherapy drugs at once instead of two shrank more tumours and delayed progression, at the cost of more side effects.
TRIBE randomised 508 patients with untreated metastatic colorectal cancer to FOLFIRI plus bevacizumab or FOLFOXIRI plus bevacizumab, up to twelve cycles followed by fluorouracil and bevacizumab maintenance. Median progression-free survival was 12.1 against 9.7 months (hazard ratio 0.75, 95% CI 0.62 to 0.90, p=0.003) and the objective response rate 65 against 53 percent (p=0.006). Overall survival was longer but not significantly so in the primary report (31.0 against 25.8 months, hazard ratio 0.79, p=0.054). Grade 3 or 4 neurotoxicity, stomatitis, diarrhoea and neutropenia were all more common with the triplet. TRIBE is why FOLFOXIRI plus bevacizumab is chosen when tumour shrinkage matters most: in BRAF-mutant disease, in young fit patients and when liver metastases might be made resectable.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
508 randomised.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Progression-free survivalprimary | FOLFOXIRI plus bevacizumab | - | 12.1 months | 0.75 (0.62 to 0.9) | 0.003 | link |
| FOLFIRI plus bevacizumab | - | 9.7 months | ||||
| Overall survival | FOLFOXIRI plus bevacizumab | - | 31 months | 0.79 | 0.054 | link |
| FOLFIRI plus bevacizumab | - | 25.8 months |
Shares Irinotecan (and liposomal irinotecan), FOLFIRI (5-FU, leucovorin, irinotecan), Oxaliplatin, VEGF / VEGFR.
Shares Irinotecan (and liposomal irinotecan), VEGF / VEGFR, Fluorouracil (5-FU), Anti-angiogenic therapy.
Shares Irinotecan (and liposomal irinotecan), FOLFIRI (5-FU, leucovorin, irinotecan), VEGF / VEGFR, Fluorouracil (5-FU).
Shares FOLFIRI (5-FU, leucovorin, irinotecan), Fluorouracil (5-FU), Anti-angiogenic therapy, Bevacizumab.
Shares Irinotecan (and liposomal irinotecan), FOLFIRI (5-FU, leucovorin, irinotecan), Fluorouracil (5-FU), Topoisomerase-I inhibitors (and ADC payloads).
Shares VEGF / VEGFR, Anti-angiogenic therapy, Bevacizumab, Cytotoxic chemotherapy.
Shares FOLFOXIRI (5-FU, leucovorin, oxaliplatin, irinotecan), FOLFIRI (5-FU, leucovorin, irinotecan), Topoisomerase-I inhibitors (and ADC payloads), Platinum agents.
Shares CAIRO5, Oxaliplatin, Fluorouracil (5-FU), Platinum agents.