Survival Outcomes of Bevacizumab Beyond Progression in Metastatic Colorectal Cancer Patients Treated in US Community Oncology

Cartwright, Thomas H.; Yim, Yeun Mi; Yu, Elaine; Chung, Hsingwen; Halm, Melissa; Forsyth, Michael

doi:10.1016/j.clcc.2012.05.005

Cited by 37 publications

(24 citation statements)

References 16 publications

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“…Several analyses have suggested a strong correlation between bevacizumab duration and its efficacy, and it was assumed that continuing bevacizumab until disease progression might be necessary to achieve maximum clinical benefit [12,[20][21][22][23][24]. In this study, approximately half (46.4 %) of patients would have continuous bevacizumab administration until initial PD, compared favorably with that of 38.7 % in ARIES study and 29 % in NO16966 study [12,22].…”

Section: Discussionmentioning

confidence: 48%

Clinical outcomes of Chinese patients with metastatic colorectal cancer receiving first-line bevacizumab-containing treatment

Bai

Zhang

et al. 2015

Med Oncol

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After the approval of bevacizumab for the first-line treatment of metastatic colorectal cancer (mCRC) in China, published information was still limited. This observational cohort study enrolled 175 mCRC patients who initiated bevacizumab-containing first-line chemotherapies at Sun Yet-sen University Cancer Center. Backbone chemotherapies included FOLFIRI (45.6 %), FOLFOX (34.9 %), and XELOX (19.5 %). Effectiveness data, safety profiles, and treatment patterns were collected and compared between oxaliplatin- and irinotecan-based groups. The median treatment durations of bevacizumab in first-line and total were equivalent between oxaliplatin- and irinotecan-based group (5.0 vs. 4.8 and 6.0 vs. 5.9 months, respectively). Median progression-free survival (PFS) was 10.6 months, and median overall survival (OS) was 24.2 months in entire population. No significant difference was found between irinotecan- and oxaliplatin-based groups in PFS (10.8 vs. 10.1 months, p = 0.21) or in OS (27.5 vs. 23.7 months, p = 0.68). Overall response rate in entire population was 38.3 %, and the disease control rate was 86.3 %. Bevacizumab-associated serious adverse events included hypertension (4.2 %), bleeding (3.6 %), proteinuria (3.0 %), venous thromboembolism (0.6 %), and wound-healing complications (0.6 %). Curative-intent surgery after conversion chemotherapy was carried out in 23 patients (13.7 %). Multivariate analyses showed that maintenance therapy (p = 0.001), resection of metastatic sites (p = 0.002), and disease-free interval (p = 0.003) were independent prognostic factors for OS survival. In spite of small discrepancies in treatment patterns, irinotecan- and oxaliplatin-based chemotherapeutic regimens are equally compatible partners for bevacizumab in first-line Chinese mCRC treatment.

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Section: Discussionmentioning

confidence: 48%

Clinical outcomes of Chinese patients with metastatic colorectal cancer receiving first-line bevacizumab-containing treatment

Bai

Zhang

et al. 2015

Med Oncol

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“…At that point, only observational retrospective results supported continuation of bevacizumab beyond first progression [11,47,48]. Two small phase II studies recently further pointed to this direction.…”

Section: Continuation Of Bevacizumab Upon Progression?mentioning

confidence: 96%

Incorporating Anti-VEGF Pathway Therapy as a Continuum of Care in Metastatic Colorectal Cancer

Papadimitriou

Rolfo

Dewaele

et al. 2015

Curr. Treat. Options in Oncol.

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Metastatic cancer was previously treated with distinctive lines of chemotherapy regimens upon disease progression or toxicity, yet the choices of therapy are actually interrelated, with the selection of a first-line regimen in part determining the choices available for subsequent treatment. Lately the therapeutic approach based on separate lines of treatment, tends to be replaced from a perspective strategical approach, that of the "continuum of care". This strategy targets to an improved overall survival, improved of quality of life and minimization of toxicity through upfront design of treatment selection and sequencing, exposure to all available drugs and minimization of unnecessary treatment. Anti-VEGF treatment has a well-documented role in this approach. Bevacizumab should be included in upfront treatment regimens for all mCRC patients independently of RAS status, unless contraindicated. Upfront bevacizumab could be combined with all available regimens since the optimal choice of backbone chemotherapy is yet to be defined. In RAS wild-type population, when metastasectomy is the target, an anti-EGFR combination is also a valid approach. Maintenance with bevacizumab and fluoropyrimidines should be considered upon intolerance of induction treatment and/or disease stabilization; maintenance with bevacizumab monotherapy should be avoided. In highly selected patients, complete treatment cessation could be also an option. Continuation with bevacizumab upon first progression and switch of the "backbone" chemotherapy is a validated approach. Patients progressing after first-line oxaliplatin regimen including bevacizumab combinations could be treated with an aflibercept-irinotecan combination. When no more options are available, regorafenib monotherapy should be the following choice. Combinations of anti-VEGF and anti-EGFR treatment have no place in this approach and are not indicated.

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“…237 The continuation of bevacizumab after progression on bevacizumab was also studied in a community oncology setting through a retrospective analysis of 573 patients from the US Oncology iKnowMed electronic medical record system. 238 Bevacizumab beyond progression was associated with a longer OS Overall, these data (along with data from the VELOUR trial, discussed later) show that the continuation of VEGF blockade in second-line therapy offers a very modest but statistically significant OS benefit. The panel added the continuation of bevacizumab to the second-line treatment options in the 2013 versions of the NCCN Guidelines for Colon and Rectal Cancers.…”

Section: Cetuximab Versus Bevacizumab In First-linementioning

confidence: 98%

Colon Cancer, Version 3.2014

Benson¹,

Venook²,

Bekaii‐Saab³

et al. 2014

J Natl Compr Canc Netw

209

174

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OverviewColorectal cancer (CRC) is the fourth most frequently diagnosed cancer and the second leading cause of cancer death in the United States. In 2013, an estimated 102,480 new cases of colon cancer and approximately 40,340 cases of rectal cancer will occur. During the same year, an estimated 50,830 people will die of colon and rectal cancers combined. AbstractThe NCCN Guidelines for Colon Cancer address diagnosis, pathologic staging, surgical management, perioperative treatment, posttreatment surveillance, management of recurrent and metastatic disease,and survivorship. This portion of the guidelines focuses on the use of systemic therapy in metastatic disease. The management of metastatic colorectal cancer involves a continuum of care in which patients are exposed sequentially to a variety of active agents, either in combinations or as single agents. Choice of therapy is based on the goals of treatment, the type and timing of prior therapy, the different efficacy and toxicity profiles of the drugs, the mutational status of the tumor, and patient preference. (J Natl Compr Canc Netw 2014;12:1028-1059 NCCN Categories of Evidence and ConsensusCategory 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate. These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Survival Outcomes of Bevacizumab Beyond Progression in Metastatic Colorectal Cancer Patients Treated in US Community Oncology

Cited by 37 publications

References 16 publications

Clinical outcomes of Chinese patients with metastatic colorectal cancer receiving first-line bevacizumab-containing treatment

Clinical outcomes of Chinese patients with metastatic colorectal cancer receiving first-line bevacizumab-containing treatment

Incorporating Anti-VEGF Pathway Therapy as a Continuum of Care in Metastatic Colorectal Cancer

Colon Cancer, Version 3.2014

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