With the evolution of tolerable maintenance regimens and data from randomized trials demonstrating the potential detriment of completely halting all systemic treatment, Dr Bendell estimates that a complete treatment holiday is offered to only about 5% of her patients. Dr Venook is a bit more comfortable with this approach, recommending it for about 1 in 5 individuals. Interestingly, Dr Venook is more comfortable giving patients a chemotherapy break than he is discontinuing bevacizumab, because of concern about a rebound in tumor cell growth off therapy.

Chibaudel B et al. Can chemotherapy be discontinued in unresectable metastatic colorectal cancer? The GERCOR OPTIMOX2 Study. J Clin Oncol 2009;27(34):5727-33. Abstract

Arnold D et al. Maintenance strategy with fluoropyrimidines (FP) plus bevacizumab (Bev), Bev alone, or no treatment, following a standard combination of FP, oxaliplatin (Ox), and Bev as first-line treatment for patients with metastatic colorectal cancer (mCRC): A phase III non-inferiority trial (AIO KRK 0207). Proc ASCO 2014;Abstract 3503.

Koopman M et al. Final results and subgroup analyses of the phase 3 CAIRO3 study: Maintenance treatment with capecitabine + bevacizumab versus observation after induction treatment with chemotherapy + bevacizumab in metastatic colorectal cancer (mCRC). Proc ASCO 2014;Abstract 3504.

Tournigand C et al. OPTIMOX1: A randomized study of FOLFOX4 or FOLFOX7 with oxaliplatin in a stop-and-go fashion in advanced colorectal cancer — A GERCOR study. J Clin Oncol 2006;24(3):394-400. Abstract