Maintenance Avastin – pro
The trial that led to the FDA approval of avastin for nonsmall lung cancer was called ECOG 4599 (NEJM abstract here), and in that trial 878 patients with previously untreated advanced NSCLC (limited to those with nonsquamous cancers, no brain metastases, no history of coughing up blood, and not on coumadin or other blood thinners) were randomized to carbo/taxol for six cycles or the same chemo with avastin 15 mg/kg every three weeks. For the patients who didn’t show progression of their cancer after six cycles of chemo, the protocol had patients stop the chemo and continue on “maintenance” avastin every three weeks, until they showed evidence of progression of their disease. Based on the overall survival benefit, the FDA approved avastin in this particular population, to be given with carbo/taxol, then followed by maintenance avastin. We don’t have trial results in which avastin is given with chemo but then there’s no maintenance therapy. There was no maintenance in the breast cancer Avastin trials but one colon cancer trial did include it.
ATLAS trial of maintenance avastin (bevacizumab) combined with tarceva (erlotinib) vs. avastin with placebo was positive in lung cancer for a significant improvement in progression-free survival (PFS). Similar results were released of the SATURN trial of maintenance tarceva vs. placebo in patients who weren’t on avastin It is important to note that only progression free survival was affected and that no detials on survival are yet available.
In 2011, a poster at the Chicago Multidisciplinary Symposium in Thoracic Oncology reported that Bevacizumab maintenance after first-line chemotherapy for advanced non–small cell lung cancer was associated with longer overall survival in a retrospective study of 403 patients who were treated in outpatient community settings. Median overall survival reached 20.9 months vs. 10.2 months, respectively.
NCCN, NSCL-F recommends maitenance Avastin for after 4-6 cycles of platin and taxane chemotherapy.
Ranpura V, Hapani S, Wu S, et al. Treatment-related mortality with bevacizumab in cancer patients. JAMA. 2011;305:487-494. Avai
Sandler AB, Gray R, Brahmer J, et al. Randomized phase II/III trial of paclitaxel (P) plus carboplatin (C) with or without bevacizumab (NSC # 704865) in patients with advanced non-squamous non-small cell lung cancer (NSCLC): an Eastern Cooperative Oncology Group (ECOG) Trial – E4599. Proc Am Soc Clin Oncol. 2005;23:2s. Abstract LBA4.
http://content.nejm.org/cgi/content/abstract/355/24/2542
nccn.org, non-small cell lung cancer