Aflibercept +/- LV5FU2 in First Line of Non-resectalbe Metastatic Colorectal Cancers

Inclusion Criteria

• Age ≥ 65 years
• General condition WHO ≤ 2
• Metastatic rectal or colonic adenocarcinoma, histologically proved on the primary tumour or a metastasis
• Metastases non-resectable and/or patient inoperable
• patients where a single agent chemotherapy combined with an anti-angiogenic agent is an appropriate approach
• At least one measurable target according to RECIST v1.1 criteria, no previously irradiated
• No previous treatment of the metastatic disease. Previous chemotherapy in an adjuvant situation completed 6 months or more before diagnosis of the metastasis is authorized.
• Adequate biological examination: Hb > or = 9 g/dl, polynuclear neutrophils > or = 1,500/mm3, platelets > or =100,000/mm3, total bilirubin 50 ml/min creatininemia or = 2+, test proteinuria over 24 hours which must be ≤ 1 g.
• Central genotyping of thymidylate synthase (TS) in blood DNA
• Patients treated with anticoagulants (coumadin, warfarin) can be included if the INR can be closely monitored. A change in anticoagulant treatment for low molecular weight heparin is preferable in order to respect indications
• Signed written informed consent obtained prior to inclusion

Exclusion Criteria

• Patients with a primary tumour in place and presenting clinical symptoms (occlusion, haemorrhage)
• History of brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis or new evidence of brain or leptomeningeal disease.
• Uncontrolled hypercalcemia
• Uncontrolled hypertension (SBP > 150 mmHg and DBP > 100 mmHg) or history of hypertensive attacks or hypertensive encephalopathy
• Any progressive pathology not balanced over the past 6 months: hepatic insufficiency, renal insufficiency, respiratory insufficiency,
• Any of the following within 6 months prior to inclusion: myocardial infarction, severe/unstable angina pectoris, coronary/peripheral artery bypass graft, NYHA class III or IV congestive heart failure, stroke or transient ischemic attack.
• Any of the following within 3 months prior to inclusion: Grade 3-4 gastrointestinal bleeding/hemorrhage, treatment resistant peptic ulcer disease, erosive oesophagitis or gastritis, infectious or inflammatory bowel disease, diverticulitis, pulmonary embolism or other uncontrolled thromboembolic event, wound or fractured bone
• Major surgery during the 28 days preceding the start of treatment
• Known acquired immunodeficiency syndrome (AIDS-related illnesses) or known HIV disease requiring antiretroviral treatment.
• Treatment with concomitant anticonvulsivant agents that are CYP3A4 inducers (phenytoin, phenobarbital, carbamazepine), unless discontinued >7 days.
• Anti-tumoral treatments other than the trial treatments (chemotherapy, targeted therapy, immunotherapy)
• Macronodular peritoneal carcinosis (risk of perforation)
• Known DPD deficit
• Prior history of malignant haemopathy or cancer except those treated more than 5 years ago and considered to be cured, in situ cervical carcinomas and treated skin cancers (excluding melanoma)
• Patients on new oral anticoagulant therapy (rivaroxaban XARELTOR, apixaban ELIQUIS, dagigatran PRADAXA except if relay by vitamine K antagonist therapy)
• Any contraindication to the treatments used in the trial
• Impossibility of undergoing medical monitoring during the trial for geographic, social or psychological reasons