Bevacizumab, a recombinant humanized mAb, binds to all isoforms of human VEGF with high affinity and prevents the binding of VEGF to its receptor. For esophageal cancer, bevacizumab is in the early stages of clinical development. Most trials have been limited to GE adenocarcinomas, given the life-threatening hemoptysis described in bevacizumab-treated patients with squamous cell carcinoma of the lung. A multi-center phase II study of irinotecan, cisplatin, and bevacizumab in 20 patients with unresectable or metastatic gastric or GE adenocarcinoma has shown encouraging preliminary results. Shah and colleagues reported an 87% control rate (PR/SD). Of the 10 patients with measurable disease who completed at least two cycles, the investigators reported PRs in five (50%), minor PRs in four (40%), and stable disease in one. The combination therapy was well tolerated, although, as detailed in a recent update, six (25%) of 24 patients developed thromboembolic events, one patient had a gastric perforation, and another had a near perforation on imaging. There are a number of ongoing trials with various chemotherapy agents. A phase II study of Taxotere and Avastin has recently been reported in an abstract form.
Given that most patients with locally advanced esophageal cancer are treated with concurrent chemoradiation, there may also be a possible integrative role for VEGF blockade and this is being studied in clinical trials.
William P. Tew, David P. Kelsen, David H. Targeted Therapies for Esophageal Cancer
Ilson The Oncologist, Vol. 10, No. 8, 590-601, September 2005;
Phase II study of bevacizumab and docetaxel in metastatic esophageal and gastric cancer
Sub-category: Multidisciplinary Treatment
Category: Esophagus and Stomach
Meeting: 2006 Gastrointestinal Cancers Symposium
Abstract No: 68
Author(s): P. C. Enzinger, P. Fidias, J. Meyerhardt, K. Stuart, C. Fuchs, M. Huberman, R. Goldstein, M. Attawia, C. Lawrence, A. X. Zhu
nccn.org, esophageal cancer