Objective: To evaluate the efficacy and safety of bevacizumab and capecitabine in the first-line treatment of elderly patients with metastatic colorectal cancer (mCRC). Methods: A total of 76 elderly patients with metastatic colorectal cancer rst-line treated with (5–7.5 mg/kg, d1, q3w) combined with capecitabine (1 000–1 250 mg/m2, bid, d1–14, q3w) between January 2013 and December 2016 were collected. e e cacy and adverse events (AEs) were carefully analyzed. Results: A er treated with bevacizumab combined with capecitabine, the overall e ective rate was 36% and the disease control rate was 73%. e median progression-free survival and overall survival were 10.6 months and 18.2 months, respectively; 39 patients (51%) developed grade 3 and 4 AE, the most common were hand-foot syndrome (18%), diarrhea (10%) and deep vein thrombosis (7%); four patients died due to treatment-related adverse events. Conclusion: For elderly mCRC patients who are not eligible for multidrug chemotherapy, bevacizumab combined with capecitabine is an e ective treatment option.