Article and Video CATEGORIES

Cancer Journey

Search By

What is the Role of Bevacizumab in Stage IV NSCLC?
Sat, 04/16/2016 - 06:00
Author
GRACE Videos and Articles
 

GCVL_LU-F09_Bevacizumab_Role_Stage_IV_NSCLC

 

Dr. Jack West, Swedish Cancer Institute, discusses the anti-angiogenic agent bevacizumab (Avastin) and the trial evidence of its efficacy for non-squamous NSCLC.

 

 

Transcript

In addition to standard chemotherapy, usually a two drug combination, we sometimes add a third drug called Avastin, also known as bevacizumab. Now this is not a standard chemotherapy agent — instead Avastin acts as an anti-angiogenic therapy, that is, it blocks the tumor’s blood supply, and it is sometimes included in the treatment regimen really only for the patients who have a non-squamous cancer.

Why is that? Well, years ago when Avastin was first being studied in many different kinds of patients with lung cancer — non-small cell lung cancer, either squamous or non-squamous, we found that a significant minority of patients had problems with bleeding complications, specifically coughing up blood that reached a potentially life-threatening or fatal level. That was found to be almost always limited to the patients with squamous histology. So obviously we decided that was not the way to go, and studies after that really limited treatment with Avastin to patients with non-squamous lung cancer. After that we found that even though you could have bleeding complications in a small minority of patients, it was much less of a concern when Avastin is limited to patients with non-squamous lung cancer.

Now, it is FDA approved in combination with two-drug chemotherapy, specifically the combination of carboplatin and Taxol, also known as paclitaxel. That’s because a key trial known as ECOG 4599, which was done across many different centers in North America, compared standard chemotherapy with carboplatin and paclitaxel or Taxol, to the same chemotherapy with Avastin added to it. The study found that patients tended to live longer by an average of about two months. Because of that, and the tolerable side effect profile, it became standard of care to at least consider adding Avastin to the two-drug chemotherapy combination for patients with non-squamous histology.

Now importantly, a couple of other studies have been done since that time, also using Avastin, that didn’t clearly show a survival benefit, and because of that, Avastin is really considered an option but not an absolute mandate, and many oncologists do not routinely use it for most or all of their patients. It’s something to discuss with a patient perhaps, but for patients who have a history of brain metastases or any potential bleeding complications, it may not be advisable because the safety may be enough of a concern to minimize that, and it has not consistently shown a survival benefit after that ECOG trial that I mentioned. But, for some patients it is reasonable to do a two-drug combination of chemotherapy, whether that is carboplatin and Taxol, or perhaps a different one such as carboplatin and Alimta, also known as pemetrexed, while adding Avastin to that.

Next Previous link

Previous PostNext Post

Related Content

Forum Discussions

Hi JW and welcome to Grace. I'm sorry you're going through this but hopefully and probably this isn't cancer. There is so much going on anatomically in that area that the...

Thanks Janine! I really appreciate your feedback. Had the CT and it came back all clear, huge relief! Going the physical therapy route which has already made a big difference. Root...

That is fantastic J_W! We really appreciate your follow-up. So many people find us through the same route you've taken/pinched nerve and like people with a cancer diagnosis it's important to...

Hi and welcome to Grace. I'm so sorry about your mom's situation, it's very complicated and not at all reasonable for us to comment on all that is being taken into...

Hi Scruboak, I will ask Dr. West to comment, it may be tomorrow. He's an expert in the field and will have thoughtful input. The fact that it was caught and...

I asked Dr. West and he said that this is a question he can't answer, we don't have studies that give details that specific. He said to his knowledge, that this...

Thank you so much, Janine. It helps me to just chill overall.

Recent Comments

JOIN THE CONVERSATION
That is fantastic J_W! We…
By JanineT Forum … on Thu, 05/26/2022 - 09:40
Thanks Janine! I really…
By JanineT Forum … on Wed, 05/25/2022 - 16:19
Hi JW and welcome to Grace. …
By JanineT Forum … on Mon, 05/16/2022 - 10:52
All's good
By JanineT Forum … on Sat, 05/14/2022 - 15:10