This analysis of three large studies found that Avastin (chemical name: bevacizumab) and chemotherapy improved the length of time women lived without newly diagnosed metastatic breast cancer growing by about 31% compared to chemotherapy alone. The results were reported at the 2010 European Breast Cancer Conference.
Metastatic breast cancer is cancer that has spread outside the breast to another part of the body.
Avastin is anti-angiogenesis targeted therapy. Avastin works by blocking the growth of new blood vessels that cancer cells depend on to grow and function. The vascular endothelial growth factor (VEGF) protein makes new blood vessels grow in cancer cells. Avastin blocks the VEGF protein.
Avastin is approved by the U.S. Food and Drug Administration to be used in combination with Taxol (chemical name: paclitaxel) to treat metastatic HER2-negative breast cancer that hasn't been treated with chemotherapy. Avastin also is used to treat advanced-stage lung, colon, and kidney cancer. Avastin is given intravenously.
The analysis reviewed here is called a meta-analysis because it analyzes the results of several different studies. All the studies compared how metastatic breast cancer responded to chemotherapy with or without Avastin as the first treatment. Each study used different chemotherapy medicines. The combinations were:
Anthracyclines include:
Taxanes are:
Almost 2,700 women diagnosed with metastatic breast cancer participated in the studies. None of the women had previously been treated for metastatic breast cancer.
Women who got Avastin and chemotherapy lived 21% to 40% longer (an average of 31% longer) without the cancer growing (called progression-free survival) compared to women who got only chemotherapy.
Women who got Avastin and chemotherapy also were 85% more likely to have a response to treatment compared to women who got only chemotherapy.
Overall survival (with or without the cancer growing) was 12% better in women who got Avastin and chemotherapy compared to women who got chemotherapy alone. This difference in overall survival wasn't significant, which means that it could have been due to chance and not because of the difference in treatment.
Common side effects of Avastin include high blood pressure, nosebleeds, and extra protein in the urine. Avastin also may cause weakness, pain, and diarrhea. Avastin may cause other serious side effects, including a higher risk of stroke or heart problems, kidney malfunction, and reduced white blood cell count. In the three studies, women who got Avastin were more likely to have high blood pressure, protein in the urine, heart problems, and nerve pain.
These results suggest adding Avastin to chemotherapy as the first treatment for metastatic breast cancer has some benefits. Still, some doctors believe that the benefits are small and may be outweighed by the risk of serious side effects from Avastin. Avastin also is expensive: treatment can cost $30,000 to $40,000 per month. Insurance coverage varies, but some people receiving Avastin may have to pay part of the cost.
If you've been diagnosed with metastatic breast cancer, together you and your doctor will develop a treatment plan that will likely include chemotherapy and possibly hormonal therapy and/or targeted therapy medicines such as Avastin. As you talk about your treatment, ask your doctor:
With all the information, you and your doctor can decide on a treatment plan that makes the most sense for you and your unique situation.
Learn more about Avastin, how it works, and how it's used to treat advanced-stage breast cancer in the Breastcancer.org Targeted Therapies section.
BARCELONA (MedPage Today) -- Progression-free survival in metastatic breast cancer improved by almost a third in women who received bevacizumab (Avastin) in addition to chemotherapy as first-line treatment, a meta-analysis of clinical trials showed.
The analysis showed a trend toward improved overall survival with chemotherapy plus bevacizumab compared with chemotherapy alone. Response rate increased by 85% in women who received the targeted agent, according to results reported here at the European Breast Cancer Conference.
"What we saw was that the progression-free survival was better with bevacizumab," Jose Roberto Rossari, MD, of Institut Jules Bordet in Brussels, Belgium, said in an interview. "We did not see an improvement in overall survival, but we did see a trend, which is an interesting finding."
Of the improvement in overall response rate, Rossari said "When you need a response in a patient with metastatic breast cancer, giving bevacizumab with chemotherapy improves the chances."
The findings were based on a meta-analysis of three large clinical trials. All of the trials compared standard chemotherapy plus bevacizumab or placebo as first-line therapy for metastatic breast cancer. Each of the trials demonstrated significant improvement in PFS and overall response rate with the addition of bevacizumab, but the magnitude of the benefit varied among the studies.
The purpose of the meta-analysis was to define more precisely the benefits and risks of combining bevacizumab with chemotherapy in the first-line metastatic setting, said Rossari.
Each of the trials evaluated bevacizumab in combination with a different type of chemotherapy. Bevacizumab was combined with paclitaxel in one trial, with docetaxel in one, and with an anthracycline or a taxane in the third trial.
The paclitaxel trial was open label without a placebo, and the other two were placebo-controlled. The trials involved a total of 2,695 patients with previously untreated metastatic breast cancer.
The primary endpoint of the analysis was the same one used in each of the trials: progression-free survival. Rossari and colleagues also wanted to determine more precisely the impact of bevacizumab on response rate and overall survival and to assess the toxicity associated with adding the targeted agent to chemotherapy.
In the individual trials, the progression-free survival hazard ratio ranged from 0.60 to 0.79. The meta-analysis produced a hazard ratio of 0.69, reflecting a 31% reduction in the risk of progression (95% CI 0.63 to 0.76).
With respect to overall response, the individual trials found odds ratios for response of 1.54 to 2.14. The meta-analysis resulted in an odds ratio of 1.85, reflecting an 85% improvement in the odds for objective response with bevacizumab (95% CI 1.57 to 2.18).
Hazard ratios associated with overall survival ranged from 0.68 to 1.03 in the individual trials -- none of which proved to be statistically significant.
And while the pooled analysis produced an odds ratio of 0.88 -- 12% improvement in overall survival with bevacizumab -- the difference remained nonsignificant (95% CI 0.78 to 1.00).
Bevacizumab was associated with significantly more grade 3-4 adverse events, including hypertension (OR 5.17, 95% 1.35 to 19.78), proteinuria (4.83, 95% CI 2.41 to 9.71), sensory neuropathy (OR 1.53, 95% CI 1.14 to 2.06), and cardiac dysfunction (3.04, 95% 1.25 to 7.31), but not gastrointestinal perforation (OR 2.07, 95% CI 0.72 to 5.93).
Rossari reported no disclosures.
Primary source: European Breast Cancer Conference Source reference: Rossari J, et al "Bevacizumab combined with chemotherapy as first-line treatment of metastatic breast cancer patients: a meta-analysis based on studies having randomized 2,695 patients" EBCC 2010; Abstract 122.
Breastcancer.org 7 East Lancaster Avenue, 3rd Floor Ardmore, PA 19003
Learn more about our commitment to your privacy
© 2010 Breastcancer.org - All rights reserved.
Breastcancer.org is a non-profit organization dedicated to providing information and community to those touched by this disease. Learn more about our commitment to providing complete, accurate, and private breast cancer information.
