First-Line Bevacizumab-Containing Therapy for Triple-Negative Breast Cancer: Analysis of 585 Patients Treated in the ATHENA Study

Abstract

Background: The prognosis for patients with triple-negative breast cancer (TNBC) is poor and treatment options are limited. Bevacizumab improves the efficacy of standard first-line therapy in locally recurrent/metastatic breast cancer (LR/mBC). The benefit of bevacizumab seen in patients with TNBC appears similar to that observed in the overall population. We conducted an exploratory analysis of patients with TNBC treated in the single-arm routine oncology practice ATHENA study. Methods: Patients with previously untreated LR/mBC received standard first-line chemotherapy combined with bevacizumab (10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks, until progression, unacceptable toxicity, or patient/physician decision). Results: Of 2,264 patients treated in ATHENA, 585 (26%) had TNBC. Most patients received single-agent taxane with bevacizumab. In the TNBC subgroup, the overall response rate was 49%, including complete responses in 10%; only 16% had primary resistant disease. Median time to progression was 7.2 months (95% CI 6.6–7.8) and median overall survival was 18.3 months (95% CI 16.4–19.7). The 1-year overall survival rate was 60%. The safety profile in TNBC was consistent with results in the overall population. Conclusion: This exploratory subgroup analysis suggests that first-line chemotherapy in combination with bevacizumab is an active regimen in patients with metastatic TNBC.

Paclitaxel and bevacizumab with or without capecitabine as first-line treatment for HER2-negative locally recurrent or metastatic breast cancer: A multicentre, open-label, randomised phase 2 trial

“…Recent attention has focussed on the search for subgroups among advanced breast cancer patients deriving the greatest benefit from bevacizumab. In a search for clinical evidence, primarily retrospective of nature, a beneficial effect of (A) (B) bevacizumab has been suggested in advanced TNBC [1,33]. A recent meta-analysis of individual patient data from E2100, AVADO and RIBBON-1 reaffirmed these earlier results showing significant improvement in PFS from a median of 5.4 to a median of 8.1 months when bevacizumab was added to first-line chemotherapy in TNBC (pooled HR 0.63, 95% CI 0.52-0.76; p < 0.0001) [34].…”

Metastatic triple negative breast cancer: Optimizing treatment options, new and emerging targeted therapies

“…37 In the IMELDA study, maintenance capecitabine and bevacizumab (vs bevacizumab alone) after initial first-line bevacizumab and docetaxel for patients with HER2-negative metastatic BC was associated with significantly improved PFS and OS. This improvement in the outcome was also seen in the TNBC subgroup (Table 2).…”

Use of Bevacizumab as a First-Line Treatment for Metastatic Breast Cancer

“…Subgroup analyses have also been reported in observational settings. In the athena cohort, the median time to progression was 10.4 months [95% confidence interval (ci): 8.8 to 11.8 months] for the subgroup of patients 70 years of age and older (n = 175) 24 and 7.2 months (95% ci: 6.6 to 7.8 months) for the triple-negative breast cancer (tnbca) subgroup (n = 585) 25 . The small size of the elderly and tnbca subgroups in the randomized clinical trials might explain the absence of a statistically significant improvement in those groups (Figure 2).…”