- Question from Clazz: Has Avastin proved effective for liver metastases? Is it in a trial phase? Who is administering the trial?
- Answers —Hope Rugo, M.D.: Avastin (chemical name: bevacizumab) was studied in combination with Taxol and treatment for metastatic breast cancer in women who had not yet received chemotherapy for metastatic disease. In that trial, it appears that the response to Taxol was doubled by adding Avastin. The response lasted twice as long in the patients who got Avastin compared to those who got Taxol alone.
There is a suggestion from that study that the patients who got Avastin might also be living longer, but the data is still very early. Patients on this trial had the disease in various places, and many had disease in the liver. So it would be expected that some patients with disease in their liver would have a response to Avastin given in combination with Taxol.
Whether or not this combination is effective in women who have already received treatments for metastatic breast cancer remains to be seen, and there are a number of trials that will be started in the near future because of the excitement over the data you have mentioned.
- Jennifer Armstrong, M.D.: One of the discussions at ASCO was while we do not yet know how much Avastin might add to other regimens (and as Dr. Rugo mentioned, we don't yet know how it might add to second or third line regimens), it was suggested that the data is persuasive for patients with newly diagnosed metastatic breast cancer initiating first line therapy. To my knowledge, Avastin is not yet FDA approved in this use. May I ask, Dr. Rugo, if you had a patient with metastatic breast cancer in whom you were starting first line therapy with a taxane, are you currently using Avastin?
- Hope Rugo, M.D.: I have used Avastin where women are not eligible for treatment on a clinical trial, or have had a poor response to initial therapy. The problem at present is that Avastin is very expensive, and until we have more data telling us exactly how to use this agent in breast cancer, it will be hard to use the drug routinely in all women as first line treatment of metastatic breast cancer.
However, I have had some patients on trial with Avastin who have had good and long-term response so I already had experience in using the agent, which helps. Oncologists specializing in breast cancer in the U.S. are talking continuously about how we are designing the next line of studies that will expand on the use of Avastin for both early and late stage breast cancer. This will help us to understand which patients are most likely to benefit from this treatment.
- Jennifer Armstrong, M.D.: It really is a very exciting time. One thing we didn't mention above was that in addition to relying on evidence-based medicine, FDA approval is needed to reform reimbursement. So there can be problems with payment and reimbursement when using Avastin off-protocol for breast cancer. These are important issues to identify.
On Wednesday, June 15, 2005 our Ask-the-Expert Online Conference was called Updates from the 2005 ASCO Annual Meeting. Hope Rugo, M.D. and moderator Jennifer Armstrong, M.D. answered your questions on the latest research advances presented at the 2005 American Society of Clinical Oncology meeting in Orlando, FL.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Hope S. Rugo, M.D. is a clinical professor of medicine in the division of hematology and oncology at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, where she directs the Breast Oncology Clinical Trials Program.
Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.
