Taxol With Avastin Produces Noteworthy Results, Indiana University Breast Cancer Researcher Reports In NEJM
Main Category: Breast CancerAlso Included In: Clinical Trials / Drug Trials
Article Date: 28 Dec 2007 - 1:00 PDT
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The positive results of the first nationwide clinical study showing the benefits of an antiangiogenic agent in breast cancer therapy are reported in the Dec. 27 issue of the New England Journal of Medicine.
The study with Avastin showed the biggest improvement in metastatic breast cancer ever reported in a chemotherapy-based clinical trial. It nearly doubled the time between initiation of chemotherapy for metastatic disease and progression of the breast cancer tumors.
The study was coordinated by the Eastern Cooperative Oncology Group (ECOG) and Kathy Miller, M.D., associate professor of medicine and Sheila D. Ward Scholar at the Indiana University School of Medicine, is the lead author.
Dr. Miller said she found the results exciting because this was the first study to show that an antiangiogenic agent can delay progression of advanced breast cancer. The study looked at Taxol (paclitaxel), which is one of the standard agents for metastatic disease, with and without the addition of Avastin (bevacizumab).
"This study not only achieved the longest progression-free survival in advanced disease but the therapy achieved that improvement without adding to the day-to-day treatment burden and with only minor increases in toxicity," said Dr. Miller.
The study enrolled 722 women with metastatic disease from the United States, Canada, Peru and South Africa. Patients were randomized to one of two arms of the phase III study Taxol alone or Taxol with Avastin. The patients, who joined the study from December 2001 through May 2004, represented a balance of age, disease-free interval, estrogen-positive receptors and sites of disease.
The results show that treatment with Taxol and Avastin increased the period patients went without progression of their disease from 5.9 months to 11.8 months.
"The next step is to move Avastin into the initial treatment of breast cancer in hopes that it will prevent recurrence in the first place," said Dr. Miller.
Avastin is a human monoclonal antibody that acts to reduce the development of blood vessels that feed tumors. Cancer tumors need an increasing supply of blood to grow and the development of the blood vessels to supply the tumor is a process called angiogenesis. Avastin already has been approved by the Food and Drug Administration for treatment of colorectal and lung cancer.
The first clinical study with Avastin in humans was done in 1997 at Indiana University School of Medicine by George W. Sledge Jr., M.D., a pioneer in the field of antiangiogenic research. Dr. Sledge, a breast cancer specialist and the Ballve-Lantero Professor of Oncology, also conducted a 1998 Avastin study for breast cancer patients. Both early studies produced positive results.
Indiana University
http://www.indiana.edu
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Avastin For Breast Cancer
posted by Gregory D. Pawelski on 29 Dec 2007 at 1:45 pmAvastin works by choking off the blood vessels that provide a tumor with oxygen and nutrients (angiogenesis). Angiogenesis is essential for the growth and metastasis of cancer. With Avastin, the target is not the cells themselves but rather VEGF secreted by the tumor cells.
At a critical point in the growth of a tumor, the tumor sends out signals to nearby endothelial cells to activate new blood vessel growth. One of the endothelial growth factors (VEGF) is expressed by many tumors (but not all) and seems to be important in sustaining tumor growth.
Avastin complexes with free VEGF and blocks its action. And when you use Avastin as an anti-angiogenic enhancer and potentiator, the abrogating effect of it upon VEGF reduces the secretion of VEGF by the tumor cells.
It both reduces VEGF and makes Avastin work better, possibly overcoming tumor resistance to Avastin.
The idea that approving drugs based on population studies has its limits. What may or my not work for the average population may not apply to the individual. Avastin doesn't have to be used in every breast cancer patient. Taxol doesn't have to be used in every cancer patient either.
The clinical trial was done using Avastin in combination with Taxol. Doctors are faced with a problem of whether to use Taxol and forgo Avastin, or to use some other conventional drug for initial therapy in order to use Avastin.
Having a good tumor-drug match not only would improve survival rates, it would be cost-effective, and the high cost of the newer cancer therapies reinforces the necessity of choosing the right therapy the first time around.
The tumors of different patients have different responses to chemotherapy. It requires individualized treatment based on testing the individual properties of each patients’ cancer.
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