ANCHOR Phase III: Oral Anlotinib Fails to Displace Bevacizumab in First-Line mCRC: Signal Transduction and Targeted Therapy | September 2026

Introduction:

Bevacizumab plus chemotherapy remains an established first-line option for metastatic colorectal cancer (mCRC). ANCHOR tested whether the oral multitargeted TKI anlotinib + CapeOX could provide a convenient alternative to bevacizumab + CapeOX in RAS/BRAF wild-type disease.

Why was this study needed?

Oral antiangiogenic therapy could simplify treatment delivery.

Anlotinib has activity across multiple angiogenic pathways.

Phase III evidence was required to demonstrate non-inferiority to bevacizumab.

Key Findings:

748 patients with unresectable RAS/BRAF wild-type mCRC were randomized.

Median PFS was identical: 11.0 months in both groups.

However, non-inferiority was not demonstrated because the upper confidence limit exceeded the prespecified margin.

Grade ≥3 treatment-related adverse events were higher with anlotinib: 64.9% vs 44.8%.

Similar median PFS therefore should not be interpreted as equivalent efficacy.

The exclusively Chinese study population may limit wider generalizability.

Bottom Line:

Anlotinib did not establish non-inferiority to bevacizumab and caused greater toxicity. ANCHOR provides no rationale for replacing bevacizumab with anlotinib in first-line mCRC.