From the Desk of Dr. Lenz
Avastin in Stage II and III Colon Cancer
In the plenary session at ASCO this year there was a presentation of a large NASBP trial which tested whether the addition of Avastin® (bevacizumab) to 6 months of FOLFOX would decrease tumor recurrence.
The data suggested that there was no benefit with the addition of Avastin, which was given not only for 6 months along with chemotherapy but 6 months in addition to FOLFOX for a total of 12 months.
Despite showing this was a negative clinical trial, when the investigators and Genentech looked at the 1 year disease free survival it appeared there was a potential transient benefit which lasted longer than the 1 year Avastin was given. Whether this is real or a fluke no one knows. However even considering that this is a real benefit, it would be very small may be 5 percent in 3 years. That means a 5% decrease of recurrence with one year of Avastin, but also means that many patients will be treated with no benefit.
Recent data have suggested that when Avastin was given 6 months longer some concerning side effects have been see in up to 10% of patients such as body pain interfering with daily function, dizziness, and central nervous system symptoms raising questions of the safety of Avastin given for a long time, particularly compared to little benefit at all (that benefit would be possible only under the best conditions). It became clear that studies using even longer administration of Avastin would be not indicated.
Fortunately there is a similar trial which was completed in Europe. The data will be hopefully available next year at ASCO and will answer whether this “transient” change is real which is more exciting for the tumor biology than clinical benefit or all a fluke.
Another question, of course, is will the clinical trials using Erbitux become effective in the adjuvant setting. In the US N0147 is again open and only enrolling wild-type KRAS for this trial.
This news article was originally posted on June 7th, 2009 and was accurate at the time of publication. Since then, information may have changed or links may now be outdated. Please call our Answer Line 1-877-427-2111 for the latest information, or talk to your doctor before making any medical decisions.
Posted by Heinz-Josef Lenz, MD on June 7th, 2009
Tags: adjuvant chemotherapy, ASCO 2009, Avastin, Treating Colorectal Cancer
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Maen Addassi
June 8, 2009 at 9:03am
I think the Avastin is a big bubble should be finished for example:
1. Colorectal Cancer: with Oxaliplatin was not impressive. Only with Irinotecan also a negative result in early cancer
2. Breast cancer with old product called Paclitaxel was given a good result (only progression free survival not overall survival) but in the other hand with the newest & most common drug Docetaxel with a trial called Avado trial ; it seems the result was not so impressive they tried to promoted the Hazard ratio rather than a clinical result. The median time to disease progression was 8 months with docetaxel alone, compared with 8.7 months with docetaxel plus low-dose bevacizumab, and 8.8 months with docetaxel plus high-dose Bevacizumab it is 0.8 months = 24 days !!!
3. Lung cancer : at the beginning with Paclitaxel it was made a good survival a trial called E4599 by A Sandler published at 2006 at NEJM it is add 2 months for overall survival (from 10.2 to 12.2 ) with a double dose and of course a double cost. And at ATLAS study with Tarceva 1.3 Month more !!!
4. Renal cell carcinoma : same story; without any advantages regarding survival
Kindly note the British health system was refused Avastin for CRC and/or other indications due to lack cost effectiveness. They approved Cetuximab rather than Avastin
Is it worth this!!!
Heinz-Josef Lenz
June 8, 2009 at 9:43am
very well said. not that i dont use avastin but we need to know when and how. HJL
j.d.
June 8, 2009 at 12:59pm
When will data become available on NO147? Are there any preliminary results?
Heinz-Josef Lenz
June 8, 2009 at 1:05pm
hopefully in one year HJL
Heinz-Josef Lenz
June 8, 2009 at 1:05pm
but probably two years…..