Unplanned interim analysis by DSMB indicated possible reduced response rate with the addition of Ca/Mg in pooled population. Further analysis pending.

The primary rationale for this study is to develop an optimized schedule of administration of FOLFOX + bevacizumab that maximizes the efficacy and safety of this regimen when administered to patients with advanced colorectal cancer. The hypothesis is that the use of an intermittent oxaliplatin (IO) schedule of FOLFOX/bevacizumab will allow these patients to continue on treatment for a longer period of time by reducing the proportion of patients who discontinue therapy early because of treatment-related toxicities and thus increasing the possibility of a longer time to progression.

The primary objective is:

• To test the hypothesis that an intermittent oxaliplatin (IO) schedule of FOLFOX/bevacizumab will allow patients to remain on therapy for a longer period of time compared to a conventional "treat-to-failure" schedule, by reducing the proportion of patients who discontinue therapy for treatment-related toxicities.

The secondary objectives are:

• To evaluate the impact of calcium/magnesium infusions on the incidence and severity of neurotoxicity in subjects receiving either the IO or conventional FOLFOX/bevacizumab treatment schedules as first-line treatment for metastatic colorectal cancer.
• To evaluate the safety and efficacy of the IO versus the conventional schedule + calcium and magnesium infusions, as part of oxaliplatin-based first-line therapy for metastatic colorectal cancer.

The following information on clinical trials is provided for information purposes only to allow patients and physicians to have an initial discussion about the trial. This information is not intended to be complete information about the trial, to contain all considerations that may be relevant to potential participation in the trial, or to replace the advice of a personal physician or health professional.

Inclusion Criteria:

• Histologically or cytologically documented metastatic, measurable adenocarcinoma of the colon, rectum, or appendix with no prior therapies for metastatic disease
• ECOG performance status (PS) of 0 or 1
• Adequate hematologic, renal, and hepatic function as defined by required baseline laboratory parameters
• No other serious concomitant disease.

Exclusion Criteria:

• Peripheral neuropathy > Grade 1 at baseline
• History of significant cerebrovascular, cardiovascular, or peripheral vascular disease
• Uncontrolled hypertension (defined as blood pressure > 150/100 mmHg)
• History of abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess, within 6 months prior to start of study drug
• Minor surgical procedure, fine needle aspiration, or core biopsy within 7 days prior to start of study drug
• Serious, non-healing wound, ulcer, or bone fracture
• Active gastroduodenal ulcer
• Evidence of bleeding diathesis or coagulopathy
• Significant history of bleeding within 6 months prior to registration
• Prior history of hypertensive crisis or hypertensive encephalopathy