We often get asked about Avastin for brain tumour treatment in the UK. Here’s where things are at the moment…
Sadly, Avastin for brain tumours is not the Holy Grail we all want. Research shows that for brain tumour treatment, there is not enough benefit for patients.
The drug will not change the overall survival for brain tumour patients, and whilst it may delay progression free survival this comes with a significant symptom burden. At the international SNO conference in November 2013 the results of the phase 3 trial were announced; We think everyone knew that it wouldn’t be good news but the disappointment was clear amongst the audience. This is what the results showed:
Bevacizumab (Avastin) added to the standard of care (chemoradiation [CRT] with temozolomide) as the first line treatment of glioblastoma did not improve median overall survival (OS), and, although the combination was associated with longer progression-free survival (PFS), it did not reach its prespecified target, according to results of the Radiation Therapy Oncology Group (RTOG) 0825 phase III study presented at Sunday’s Plenary Session (Abstract 1). Mark R. Gilbert, MD, of The University of Texas MD Anderson Cancer Center, presented the study.
After a median follow-up time of 20.5 months, median OS was 15.7 months for patients receiving bevacizumab plus standard of care compared with 16.1 months for patients receiving only standard therapy, resulting in a hazard ratio (HR) of 1.13 (95% CI [0.93, 1.37]; p = 0.21). PFS was longer for patients who received standard of care plus bevacizumab, as compared with patients who only received standard of care, resulting in a HR of 0.79 (10.7 months vs. 7.3 months, respectively; 95% CI [0.66, 0.94]; p = 0.007). Subgroup analysis based on MGMT promoter methylation and a 9-gene signature did not identify a group of patients who demonstrated benefit from first-line use of bevacizumab, but patients with MGMT promoter methylation and a favorable 9-gene signature showed a strong trend towards a worse outcome.
Adverse events typically seen with bevacizumab
Overall, adverse events typically seen with bevacizumab were also higher for patients receiving it as first-line therapy with respect to hypertension, deep vein thrombosis/pulmonary embolism, wound issues, gastrointestinal perforations, and significant hemorrhagic events.
Impact of Avastin on Quality of Life
Symptom burden, neurocognitive function, and quality of life (QOL) were also assessed during the study. Patients treated with bevacizumab experienced an increase in symptom burden, a decline in neurocognitive function, and a worsening of multiple components of health-related QOL (Abstract 2004). Dr. Gilbert also showed that in patients with newly diagnosed glioblastoma, it appeared that a response to first-line bevacizumab could be predicted with molecular profiling (Abstract LBA2010). However, this requires validation from an independent study. Dr. Gilbert concluded, “Until a patient subgroup has been defined, these results do not support the use of bevacizumab for newly diagnosed glioblastoma.”
As such brainstrust cannot back a campaign for its use and I think you would find it hard to win clinicians’ hearts and minds too.
You can contact us if you have any questions about Avastin
Whilst it’s good to finally have some clarity on the benefits (or not) of the drug, we are sorry it is not better news for the brain tumour community. If you have any questions, or would like to have a chat about this, why not give us a call on 01983 292405 or email firstname.lastname@example.org