Avastin for renal cell cancer – pro

Avastin is an effective treatment for renal cell carcinoma. It is FDA approved for the treatment of metastatic renal cell carcinoma in combination with interferon alfa. This is based on the AVOREN study, which revealed that the addition of Avastin® (bevacizumab) to interferon improves progression-free survival when used as initial therapy among patients with metastatic renal cell carcinoma(mRCC). The details of this randomized trial were presented at a plenary session of the 2007 annual meeting of the American Society of Clinical Oncology (ASCO.Researchers from France recently conducted a Phase III clinical trial in which Avastin plus interferon was compared with interferon alone in the treatment of metastatic RCC. This trial included approximately 600 patients who had not received prior therapy. Patients treated with Avastin/interferon had a median progression-free survival of 10.2 months, compared with 5.4 months for those treated with interferon alone. Responses occurred in 31% of patients treated with Avastin/interferon, compared with only 13% for those treated with interferon alone. The most common side effects associated with treatment with Avastin were bleeding, high blood pressure, and protein in the urine. There was a trend for improved survival (0.06) in the Avastin group.

Several studies indicate that Avastin alone is also effective for renal cell carcinoma. A randomized, double-blind, Phase II trial was conducted comparing placebo with bevacizumab at doses of 3 and 10 mg per kilogram of body weight, given every two weeks in 166 patients with renal cancer. Subjects were randomized to three groups: 40 to placebo, 37 to low-dose bevacizumab, and 39 to high-dose bevacizumab. The investigators reported that there was a significant prolongation of the time to progression of disease in the high-dose–antibody group as compared with the placebo group (hazard ratio, 2.55; P<0.001). Although there were no significant differences in survival, this study cannot rule out such a benefit due to the fact that the study was too underpowered to detect differences in survival between treatment groups that may be clinically significant. According to updated results from a phase II clinical trial presented at the 23rd annual Chemotherapy Foundation Symposium, treatment with the combination of Tarceva® (erlotinib) and Avastin® (bevacizumab) resulted in good survival among patients with metastatic renal cell carcinoma.

Current NCCN guidelines recommend Avastin as an option for crossover therapy of renal cell carcinoma after first line therapy with IL2, sorafenib or sunitinib and for first line with interferon.

Coppin C, Porzsolt F, Awa A, et al. Immunotherapy for advanced renal cell cancer. Cochrane Database Systematic Rev. 2004;3:CD001425.

Hainsworth J, Spigel D, Greco A. Combination Therapy with Bevacizumab and Erlotinib for Patients with Metastatic Clear Cell Renal Carcinoma. Proceedings from the 23rd annual Chemotherapy Foundation Symposium. New York. 2005; Abstract #22.

Aimery de Gramonta, Eric Van Cutsemb, Investigating the Potential of Bevacizumab in Other Indications: Metastatic Renal Cell, Non-Small Cell Lung, Pancreatic and Breast Cancer, Oncology Suppl. 3, 2005

Escudier B, Koralewski P, Piuzanska A, et al. A randomized, controlled, double-blind Phase III study (AVOREN) of bevacizumab/interferon/a2a vs placebo/interferon-a2a as first-line therapy in metastatic renal cell carcinoma. Proceedings from the American Society of Clinical Onclology. Chicago, IL. 2007 Abstract # 3.

NCCN KID-7, 2011

EU Guidelines on Renal Cancer 2010

Ana M. Molina and Robert J. Motzer Clinical Practice Guidelines for the Treatment of Metastatic Renal Cell Carcinoma: Today and Tomorrow The Oncologist February 2011 vol. 16 Supplement 2 45-50

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