Combining two methods of cancer treatment has resulted in increased death rates among patients dealing with the already deadly disease. Using cancer drug bevacizumab, coupled with chemotherpy indicates an increased risk of treatment-related death.

Bevacizumab (trade name Avastin) is a humanized monoclonal antibody that recognizes and blocks vascular endothelial growth factor A. VEGF-A is a chemical signal that stimulates the growth of new blood vessels (angiogenesis), especially in cancer, retinal proliferation of diabetes in the eye, and other diseases. Bevacizumab was the first clinically available angiogenesis inhibitor in the United States.

Bevacizumab is currently approved by the U.S. Food and Drug Administration (FDA) for cancers that are metastatic (have spread to other parts of the body). It received its first approval in 2004 for combination use with standard chemotherapy for metastatic colon cancer and non-small cell lung cancer. In 2008, it was approved by the FDA for use in metastatic breast cancer, a decision that generated some controversy as it went against the recommendation of its advisory panel, who objected because it only slowed tumor growth but failed to extend survival. In the US, Members of a Food and Drug Administration panel said in July 2010 that they do not see enough of a benefit from Avastin in advanced breast cancer to justify its serious risks.

The online Journal of the American Medical Association article states:

“Even though a number of FAEs (fatal adverse events) have been reported in patients treated with bevacizumab, its role in the development of these fatal events has not been definitively established. Data across bevacizumab trials reveal conflicting results regarding its associations with FAEs.”

Vishal Ranpura, M.D., of Stony Brook University Medical Center, Stony Brook, N.Y., and colleagues conducted a review and meta-analysis of published randomized controlled trials (RCTs) to determine whether bevacizumab is associated with increased rates of FAEs in patients with cancer. They continue that given the absolute risk of treatment-related mortality appears low, the use of bevacizumab should be considered in the context of overall survival benefits.

These trials included a total of 10,217 patients with a variety of advanced solid tumors. Eligible studies included RCTs in which bevacizumab in combination with chemotherapy or biological therapy was compared with chemotherapy or biological therapy alone.

The overall incidence of FAEs with bevacizumab was 2.5 percent. Compared with chemotherapy alone, the addition of bevacizumab was associated with a 1.5 times increased risk of FAEs.

Bevacizumab was associated with a 3.5 times increased risk of FAEs in patients receiving taxanes or platinum agents (3.3 percent vs. 1.0 percent), but was not associated with increased risk of FAEs when used in conjunction with other agents.

Nevertheless, bevacizumab is increasingly used in cancer patients, it is particularly important for all health care practitioners and patients to understand and recognize the risk of treatment-related mortality and to monitor closely to identify and treat serious adverse effects.

Source: Journal of the American Medical Association

Written By Sy Kraft, B.A.