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Journal of Clinical Oncology, 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 26, No 15S (May 20 Supplement), 2008: 14675
© 2008 American Society of Clinical Oncology
Role of bevacizumab as post-progression maintenance therapy in metastatic colon cancer
K. M. Galal,
M. Abdel-salam,
E. F. Esmat,
S. Mansour,
K. D. Zaghlol and
E. Mostafa
Cairo University, Cairo, Egypt; Mansura University, Mansura, Egypt; Tanta University, Tanta, Egypt
14675
Background: Colon cancer is one of the most commonly occurring cancers worldwide, with approximately 50–60% of these patients of metastatic disease and requiring systemic chemotherapy (CTh). Bevacizumab (BVC), a monoclonal antibody directed against vascular endothelial growth factor, provides a significant survival advantage when added to first-line chemotherapy for metastatic colon cancer. The question of whether to continue BVC with the next therapy regimen, and the timing of bevacizumab in the overall treatment strategy of advanced metastatic colon cancer-early use (first-line) or later use? awaits further study. Patients and Methods: Thirty three patients with progressive metastatic colon cancer after first-line therapy were included. Patients were randomized to receive either chemotherapy or combined chemotherapy with bevacizumab. The primary end point was objective response. Secondary end points were median survival, time to tumor progression, toxicity. Results: Median age was 59.7 years (range, 39–70 years), with male/female ratio of 17/16. Partial response with second-line BVC group constituted (25% and 18.8%) in patients with first-line chemotherapy and BVC-based regimen respectively, compared to (11.8% and 5.9%) with second-line chemotherapy (P = 1.01). Median time to progression was (2.3 vs. 4.3 months) for cases with second-line chemotherapy and BVC-based regimens respectively (P=0.12). Median survival was (4 vs. 6.7 months) in both groups respectively (P=0.22). Grade III/IV of neutropenia occurred in 40%, 14.3% and 31.3% in FOLFOX, FOLFIRI and combined BVC-CTh respectively (P=0.66). Conclusion: Bevacizumab is recommended to be maintained in the second- and third-line settings. Post-progression addition of BVC showed statistically significant effect on median survival. Second-line combined bevacizumab with chemotherapy had higher disease control, median time to progression and median survival in bevacizumab- naïve patients compared to patients with first-line BVC-based therapy. Selection of patients for bevacizumab was recommended with taking into consideration the cost-benefit value and that discontinuation of BVC would increase tumor progression.
No significant financial relationships to disclose.
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