Avastin was approved for second line therapy in previously Avastin naive patients and this was followed by data anlyses that suggested that Avastin is beneficial for maintenance. A suggestion that Avastin may be modifying disease progression even after it failed to control recurrence comes from a retropective review. BRiTE (Bevacizumab Regimens: Investigation of Treatment Effects and Safety) observed progress of three groups of patients when their cancer got worse after their first chemotherapy treatments. All patients had Avastin as part of the first chemo, some continued it beyond that first cancer progression.
BRiTE patients were treated by their own oncologists in almost 250 different places in the United States. Overall median survival time for the three groups was:
No further treatment after progression: 12.6 months
Chemotherapy, no Avastin: 19.9 months
Chemotherapy with continued Avastin: 31.8 months
Median survival time after first progression
No further treatment: 3.6 months
Chemotherapy only: 9.5 months
Chemotherapy plus Avastin: 19.2 months
It stands to reason that patients who responded and are stable or had a complete response would benefit from continued Avastin. However, this is not yet confirmed. There is no prospective trial evidence and this strategy should be considered experimental until a prospective study confirms it.
There is a great deal of interest in maintenance strategies but which is best and even if any of them is beneficial over observation and retreatment is not known. One trial is: A Study of Avastin (Bevacizumab) and Xeloda (Capecitabine) as Maintenance Treatment in Patients With Metastatic Colorectal Cancer, NCT00623805. This 2 arm study will assess the efficacy and safety of maintenance treatment with Avastin + Xeloda, after initial treatment with Xeloda + oxaliplatin + Avastin, in patients with metastatic colorectal cancer. Patients will be randomized into one of 2 groups to receive 1)Xeloda + oxaliplatin + Avastin until disease progression or 2)Xeloda + oxaliplatin + Avastin for 6 x 3 week cycles, followed by Xeloda + Avastin until disease progression. This is a phase III trial. There is also: Optimal Maintenance Therapy With Bevacizumab After Induction in Metastatic Colorectal Cancer (CRC),NCT00973609, also a phase III study. This is a multicenter study. Patients are stratified according to best response during first-line chemotherapy/bevacizumab treatment (complete response and partial response vs stable disease), duration of first-line treatment (16-20 weeks vs 21-24 weeks), type of chemotherapy used during first-line treatment (irinotecan and fluoropyrimidine vs oxaliplatin and fluoropyrimidine vs fluoropyrimidine monotherapy), disease burden (one organ with metastasis vs more than one organ with metastasis), and by participating center.
•Arm I (bevacizumab maintenance therapy): Patients receive bevacizumab IV over 30 minutes on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
•Arm II (no maintenance therapy): Patients receive no further treatment; they are monitored for disease progression. There are also other smilar studies. NCCN has nto yet incorporated maintenace into its guidelines.
K.M. Galal, M. Abdelsalam, E.E. Fawzy, S. Mansour, K. Zaghloul and E.M. Mohamed Role of Bevacizumab as Post-Progression Maintenance Therapy in Metastatic Colon Cancer Journal of Medical Sciences Year: 2008 | Volume: 8 | Issue: 5 | Page No.: 452-460
Grothey, Axel, Sugrue, Mary M., Purdie, David M., Dong, Wei, Sargent, Daniel, Hedrick, Eric, Kozloff, Mark
Bevacizumab Beyond First Progression Is Associated With Prolonged Overall Survival in Metastatic Colorectal Cancer: Results From a Large Observational Cohort Study (BRiTE)
J Clin Oncol 2008 26: 5326-5334
S. Kopetz and J. L. Abbruzzese
Hidden Biases in an Observational Study of Bevacizumab Beyond Progression
J. Clin. Oncol., April 1, 2009; 27(10): 1732 - 1733.
L. M. Ellis and D. G. Haller
Bevacizumab Beyond Progression: Does This Make Sense?
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Cohn AL, Bekaii-Saab T, Bendell JC, et al. Clinical outcomes in bevacizumab (BV)-treated patients (pts) with metastatic colorectal cancer (mCRC): results from ARIES observational cohort study (OCS) and confirmation of BRiTE data on BV beyond progression (BBP). J Clin Oncol 28(suppl 15):284s. ASCO Abstract #3596.
Tabernero J, Aranda E, Gomez A, et al. Phase III study of first-line XELOX plus bevacizumab (BEV) for 6 cycles followed by XELOX plus BEV or single-agent (s/a) BEV as maintenance therapy in patients (pts) with metastatic colorectal cancer (mCRC): the MACRO trial (Spanish Cooperative Group for the Treatment of Digestive Tumors [TTD]). J Clin Oncol 28(suppl 15):261s. ASCO Abstract #3501.
Avastin in treating colon cancer which this may take serious problem in which Avastin has caused some patients to develop holes in the colon called gastrointestinal perforation
Posted by: Susan "Herbal Colonic" Jenner | September 25, 2010 at 08:05 AM
This post is very informative Xeloda and avastin can be helpful in many ways thanks for sharing this
Posted by: acl reconstruction surgery | January 31, 2011 at 06:12 AM