Does Adjuvant Bevacizumab Improve Outcomes in HER2-Negative Patients?
Posted: Monday, October 15, 2018
According to a study published in the Journal of Clinical Oncology, the addition of bevacizumab to adjuvant therapy did not increase invasive disease–free survival rates in patients with HER2-negative, node-positive, or high-risk node-negative breast cancer. Kathy D. Miller, MD, of the Indiana University Melvin and Bren Simon Cancer Center, and colleagues noted that because of the high rate of early treatment discontinuation in this trial, longer duration of bevacizumab therapy is not likely.
A total of 4,994 patients with this type of breast cancer enrolled in this double-blind phase III trial between November 2007 and February 2011. They were randomly assigned 1:2:2 to receive one of three courses of treatment: a placebo with doxorubicin and cyclophosphamide (AC) prior to weekly paclitaxel (arm A), AC and paclitaxel with adjuvant bevacizumab (arm B), or bevacizumab during AC and paclitaxel prior to bevacizumab monotherapy for 10 cycles with concurrent hormonal therapy and radiation (arm C).
At 5 years, invasive disease–free survival was 77% in arm A, 76% in arm B, and 80% in arm C. Adverse events such as myelosuppression and neuropathy were reported evenly across the study arms, but grade ≥ 3 hypertension was more common in patients treated with bevacizumab. Overall exposure to bevacizumab was limited due to significant patient withdrawals prior to completion of their assigned treatment courses. About one-quarter of patients in arm B and one-half of patients in arm C chose to discontinue bevacizumab exposure before the scheduled end of therapy.
The researchers noted, “Although the withdrawal of U.S. Food and Drug Administration approval for bevacizumab in the metastatic setting may have led some patients to discontinue therapy, most stopped as a result of an adverse event.”
