Darmkanker: Avastin en Oxaliplatin als tweede lijns en als aanvulling op traditionele chemo zou minder kans geven op recidief bij darmkankerpatiënten met stadium II en III nadat deze geopereerd zijn.

3 februari 2005: Bron: Medscape

Avastin en Oxaliplatin als tweede lijns en als aanvulling op traditionele chemo geeft minder kans op recidief bij darmkankerpatiënten met stadium II en III nadat deze geopereerd zijn, aldus gerandomiseerde studie onder 2246 patiënten na een followup van vier jaar. Ook patiënten met aangetaste lymfklieren hebben profijt van deze combinatiebehandeling met Avastin aldus de studie. Echter zijn deze cijfers echt wel zo goed? De gemiddelde overleving steeg van 10.7 maanden naar 12.5 maand met de aanvulling van Avastin. (hazard ratio 0.74, p = 0.0024). Wij durven te beweren dat mensen die hun voeding aanpassen en bepaalde extra vitamines enz. gebruiken deze verbetering ook gemakkelijk bereiken. Zeker als bv. via TACE en/of LITT enkele keren de uitzaaiïngen in de lever worden weggehaald. Avastin wordt enorm gepromoot maar wij zijn nog niet overtuigd van de echt spectaculaire verbeteringen waar velen op zitten te wachten. Toch deze studie hier gepubliceerd omdat die toch ook heel actueel is en Avastin ook in Nederlandse en Belgische ziekenhuizen verkrijgbaar is voor darmkankerpatiënten.

By Karla Gale

NEW YORK (Reuters Health) Jan 27 - The addition of bevacizumab (Avastin) and oxaliplatin (Eloxatin) to standard chemotherapy prolongs survival in patients with colorectal (CRC) cancer, according to the results of two trials presented at the American Society of Clinical Oncology GI meeting being held in Hollywood, Florida.

Dr. Aimery de Gramont, from Hopital Saint Antoine in Paris, reported on outcomes of 2246 patients with locally advanced, completely resected stage II and III colon cancer. All patients were treated with 5-fluorouracil and leucovorin every 2 weeks for 12 weeks, and approximately half were also randomly assigned to treatment with oxaliplatin (FOLFOX4 regimen).

After a median follow-up of 4 years, the researchers observed a 24% reduction in the relative risk of relapse in the FOLFOX4 group (p = 0.0008).

"There was increased survival in all subsets of patients," those with stage II or stage III disease, including those with four or more lymph nodes, Dr. de Gramont said at a press conference. "Patients relapsed at a median time of 2 years after they receive treatment, but many who have relapsed are still alive."

"The other measure of concern when we have a new treatment is safety, but with FOLFOX4 there was no increase in the amount they deteriorated during treatment." In fact, Dr. de Gramont pointed out, they found that neuropathy that had developed during treatment partially or completely resolved over time.
Dr. Bruce J. Giantonio, at the University of Pennsylvania in Philadelphia, presented outcomes for patients with previously treated advanced metastatic colorectal cancer. Patients were treated with FOLFOX4 alone (n = 289) or FOLFOX4 plus bevacizumab 10 mg/kg (n = 290).
"Bevacizumab is a monoclonal antibody that binds vascular endothelial growth factor, which is a very potent mediator of angiogenesis," Dr. Giantonio told Reuters Health. "It also has been shown to have immunological effects mediated by VEGF, plus it can affect growth of lymphatic vessels, and there is probably influence on other signaling pathways within tumor cells that affect the growth of the cells."

His group found that median survival was increased from 10.7 months to 12.5 months with addition of bevacizumab (hazard ratio 0.74, p = 0.0024).
"This is the first time that bevacizumab has been shown to be effective in a second-line setting," Dr. Giantonio said. These findings "add to existing experience that suggests bevacizumab's benefit may be independent of the particular chemotherapy given."

There have been other nonrandomized studies where survival was the endpoint, Dr. Giantonio continued, "and every other study to date in colorectal cancer using this drug has shown a clinical benefit." By moving bevacizumab to a "front-line setting we're probably going to see substantial advances" in survival.

darmkanker, bevacizumab