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Avastin Plus Chemo Benefits Lung-Cancer Patients

Treatment extended survival by 2 months, a small but significant gain, researchers say

THURSDAY, Dec. 14, 2006 (HealthDay News) -- Adding the drug Avastin to traditional chemotherapy for patients with advanced lung cancer prolonged survival by several months, a new study found.

The U.S. Food and Drug Administration has already approved Avastin (bevacizumab) for this use, based on the results of this study.

Thanks to the approval, this treatment approach could be adopted right away, said study senior author Dr. David Johnson, deputy director of the Vanderbilt-Ingram Cancer Center in Nashville, Tenn. "If I had to predict, I would say somewhere around 30 to 35 percent of patients who had advanced non-small-cell lung cancer would meet the criteria for this type of therapy," he said. "That's a substantial number of people, in the tens of thousands."

The gains from Avastin may not seem like much, Johnson noted, but they took place with a disease for which there is little hope.

"This is a tough group of patients to treat, and, in the last two decades, there has not been a lot of progress until this study," he said. "This is the first study to use a biological or targeted agent in combination with standard chemotherapy and shown a survival benefit -- a modest benefit to be sure -- but we're talking the worst of the worst of the disease."

The results are published in the Dec. 14 issue of the New England Journal of Medicine.

Lung cancer is the leading cancer killer in the United States, striking an estimated 171,000 people each year. Non-small-cell lung cancer is the most common form of the disease, accounting for about 85 percent of cases. The disease is more often diagnosed in advanced stages, at which point it is notoriously difficult to treat.

Avastin, which was originally developed to treat colon cancer, is a monoclonal antibody, which inhibits blood supply to a tumor. This "anti-angiogenesis" drug has also been used with some success in breast cancer.

For the new study, 878 patients with recurrent or advanced non-small-cell lung cancer were assigned to receive a chemotherapy regimen of paclitaxel and carboplatin alone, or the same chemotherapy regimen combined with Avastin.

The median survival period for participants who received chemotherapy plus Avastin was 12.3 months, compared to 10.3 months for the chemotherapy-alone group.

Median progression-free survival was 6.2 months in the Avastin group and 4.5 months in the chemotherapy group. There was also a better response rate in the patients treated with Avastin, which may mean the drug might have the added benefit of improving delivery of the drug to the tumor, the study authors said.

Unfortunately, there were also side effects seen in the Avastin group, notably febrile neutropenia (fever and reduction in white blood cells) and pulmonary hemorrhage.

Dr. Michael L. Grossbard is chief of the division of hematology/oncology at St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, in New York City. He said, "Obviously, this is a very bad disease, and a two-month improvement is very significant. But, most importantly, this is the first randomized trial or large multi-centered trial that has demonstrated a median survival in excess of one year for metastatic lung cancer. Avastin has really altered the landscape. Both progression-free survival and overall survival have been significantly extended, and that's pretty meaningful."

Even so, not every patient with advanced, non-small-cell lung cancer is a candidate for this type of therapy, Johnson cautioned. Study participants included only people with adenocarcinoma, which is the most common form of the disease, and excluded those with brain metastases or who had severe symptoms.

Eventually, scientists expect that the new combination can be extended to patients with earlier stages of lung cancer, providing even more benefit, Johnson said. "That's the hope," he added.

Grossbard said, "The hope would be to expand the patient population that could be treated with this and to move it into earlier stage disease so as to prevent recurrence before it even starts."

More information

Visit the National Cancer Institute for more on lung cancer.

SOURCES: David Johnson, deputy director, Vanderbilt-Ingram Cancer Center, Nashville, Tenn.; Michael L. Grossbard, M.D., chief of the division of hematology/oncology at St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, New York City; Dec. 14, 2006, New England Journal of Medicine
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