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Discontinuing bevacizumab did not lead to poorer outcomes
Miles D. J Clin Oncol. 2010;doi:10.1200/JCO.2010.30.2794.
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Results from a retrospective analysis of five phase 3 trials showed that discontinuation of bevacizumab treatment was not associated with decreased time to disease progression, increased mortality or altered disease progression pattern.
Results from preclinical studies have suggested that accelerated tumor growth, local invasion and distant metastasis appear after discontinuation of treatment with some antiangiogenic agents. To test those findings, researchers analyzed results from five double blind, placebo-controlled randomized trials of patients with metastatic renal cell carcinoma (BO17705), metastatic pancreatic cancer (BO17706), metastatic breast cancer (BO17708) and metastatic colorectal cancer (NO16966, AVF2107g). All patients (n=4,205) were treated with bevacizumab (Avastin, Genentech) or placebo.
Rates of all-cause mortality were calculated every 30 days until 210 days after last dose. Researchers analyzed time from discontinuation of bevacizumab or placebo to progression or death, whichever occurred first, in patients who discontinued bevacizumab or placebo prematurely due to adverse events. Results were calculated for the individual studies and the pooled data from the selected studies.
Mortality rates at each time point were similar for patients assigned to both bevacizumab and placebo who stopped treatment due to adverse events. The results held in both the pooled analysis and the individual trial data.
Likewise, median time from discontinuation to progression or death was similar for patients assigned bevacizumab or placebo (11.9 months vs. 11.7 months) in the pooled data set (HR=0.94; 95% CI, 0.77-1.14).
When examining results from patients who discontinued treatment for any reason, researchers found that median time to death was again similar, 10.2 months for bevacizumab vs. 9.3 months for placebo (HR=0.94, 95% CI, 0.86-1.02). Mortality rates measured every 30 days from last dose were also similar between the two groups, and pooled analysis results were in agreement with the individual trial data.
Data on patterns of disease progression were available for the studies BO17705, BO17706, BO17708 and NO16966. Researchers found that the number of new lesions was similar in those assigned bevacizumab and placebo.
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