Montes AF, et al. - Since the addition of aflibercept to FOLFIRI (fluorouracil, leucovorin, irinotecan) for second-line therapy in metastatic colorectal cancer (mCRC) patients was considered safe and efficacious in the VELOUR trial, researchers developed a nomogram including six variables to stratify patients by prognosis and determined the frequency and impact of the pragmatic use of modified schedules in real-world setting. Overall 250 mCRC cases treated with aflibercept and irinotecan-based chemotherapy were included. Good calibration and acceptable discriminatory ability were evident in the model, which included Eastern Cooperative Oncology Group performance status, tumor location, number of metastatic sites, mutational status, better response to previous treatment(s), and carcinoembryonic antigen. Internal validation for predicting overall survival (OS) and the impact of pragmatic modifications of the classic regime on effectiveness and safety in colorectal cancer patients initiating therapy with FOLFIRI-aflibercept was completed. For high-, intermediate-, and low-risk groups, the estimated median OS was 6.1 months, 12.4 months, and 22.9 months, respectively. After modified schedules, grade 3–4 adverse events were less common.