Preview

Surgery and Oncology

Advanced search

INTEGRATION OF BEVACIZUMAB IN METASTATIC COLORECTAL CANCER CHEMOTHERAPY REGIMENS IN 2 CLINICAL CENTERS IN MOSCOW AND SAINT PETERSBURG

https://doi.org/10.17650/2220-3478-2013-0-4-50-56

Abstract

The aim of this study was to estimate efficacy of first line chemotherapy with bevacizumab in metastatic colorectal cancer patients and investigate the impact of different prognostic factors on treatment outcome.

Methods.During 2004–2008 48 colorectal cancer patients were included (29 in Russian N.N. Blokhin Cancer Research Center, 19 in St. Petersburg), who had unresectable distant metastases. Primary tumor was resected in 93.8 % patients. 52.1 % had rectal cancer. 87.5 % had liver metastases, 43.8 % had more than 1 organ affected. 66.7 % received chemotherapy with bevacizumab 5 mg/kg biweekly, 33.3 % received bevacizumab 7,5 mg/kg every 3 weeks. 62.5 % patients had oxaliplatin-based regimens, 35.4 % – only fluorpyrimidines, 2.1 % – chemotherapy with irinotecan.

Results.Median time of bevacizumab use was 7.8 months. 60.3 % had objective response, 87.4 % had stable diseases during more than 6 months. Median progression-free survival (PFS) was 11.5 months. Median overall survival (OS) was 24.1 months.

Conclusions.Survival and efficacy results are comparable to international experience. Combination of fluorpyrimidines with bevacizumab had comparable efficacy to combined chemotherapy regimens with no impact on quality of life. Integration of bevacizumab in combined treatment regimens reduced the impact of negative prognostic factors on PFS and OS. 

About the Authors

N. V. Dobrova
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation


N. N. Semenov
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation


G. M. Manikhas
Municipal Clinical Oncological Dispensary, Saint Petersburg
Russian Federation


N. Yu. Antimonik
Municipal Clinical Oncological Dispensary, Saint Petersburg
Russian Federation


Yu. V. Vakhabova
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation


S. L. Gutorov
N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Moscow
Russian Federation


References

1. Hurwitz H., Fehrenbacher L., Novotny W. et al. Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 2004;350:2335–42.

2. Kabbinavar F.F., Schulz J., McCleod M. et al. Addition of bevacizumab to bolus fluorouracil and leucovorin in first-line metastatic colorectal cancer: Results of a randomized phase II trial. J Clin Oncol 2005;23(16):3697–705.

3. Giantonio B.J., Catalano P.J., Meropol N.J. et al. Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: Results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 2007;25:1539–44.

4. Saltz L.B., Clarke S., Díaz-Rubio E. et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: A randomized phase III study. J Clin Oncol 2008;26:2013–9.

5. Kabbinavar F., Hurwitz H.I., Fehrenbacher L. et al. Phase II, randomized trial comparing bevacizumab plus fluorouracil (FU)/leucovorin (LV) with FU/LV alone in patients with metastatic colorectal cancer. J Clin Oncol 2003;21:60–5.

6. Grothey A., Hedrick E.E., Mass R.D. et al. Response-independent survival benefit in metastatic colorectal cancer: a comparative analysis of N9741 and AVF2107. J Clin Oncol 2008 Jan 10;26(2):183–9.

7. Zaltz L.B., Clarke S., Diaz-Rubio E. et al. Bevacizumab in combination with oxaliplatin-based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol 2008 Apr 20;26(12): 2013–9.

8. Kabbinavar F.F., Hambleton J., Mass R.D. et al. Combined analysis of efficacy: the addition of bevacizumab to fluorouracil/lеucovorin improves survival for patients with metastatic colorectal cancer. J Clin Oncol 2005 Jun 1;23(16):3706–12.

9. Kozloff M., Yood M.U., Berlin J. et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRITE observation cohort study. Oncologist 2009;14:862–70.

10. Berry S.R., Van Cutsem E., Kretzschmar A. et al. Final efficacy results for bevacizumab plus standard first-line chemotherapies in patients with metastatic colorectal cancer: First BEAT. J Clin Oncol 2008;26(15S):4025.

11. Arnold D. et al. ASCO GI 2010. Abstract 439.

12. Prausova J. et al. Poster presented at WCGIC 2009. Abstract P-0171.

13. Welch S., Spithoff K., Rumble R.B. et al. Bevacizumab combined with chemotherapy for patients with advanced colorectal cancer: a systematic review. Ann Oncol 2010;21:1152–62.

14. Köhne C.H., Cunningham D., Di Costanzo F. et al. Clinical determinants of survival in patients with 5-fluorouracil-based treatment for metastatic colorectal cancer: results of a multivariate analysis of 3825 patients. Ann Oncol 2002;13:308–17.

15. Díaz R., Aparicio J., Gironés R. et al. Analysis of prognostic factors and applicability of Kohne's prognostic groups in patients with metastatic colorectal cancer treated with first-line irinotecan or oxaliplatin-based chemotherapy. Clin Colorectal Cancer 2005;5:197–202.

16. Schmoll H.J., Van Cutsem E., Stein A. et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 2012;23(10):2479–516.

17. Schmoll H.J., Van Cutsem E., Stein A. et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 2012;23:2479–516.

18. Vosseler S., Mirancea N., Bohlen P. et al. Angiogenesis inhibition by vascular endothelial growth factor receptor-2 blockade reduces stromal matrix metalloproteinase expression, normalizes stromal tissue, and reverts epithelial tumor phenotype in surface heterotransplants. Cancer Res 2005;65:1294–305.

19. Miles D., Harbeck N., Escudier B. et al. Disease course patterns after discontinuation of bevacizumab: pooled analysis of randomized phase III trials. J Clin Oncol 2011;29(1):83.


Review

Views: 4619


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2949-5857 (Online)