Salvage therapy of pretreated advanced breast cancer with bevacizumab and paclitaxel every two weeks: a retrospective case review study

Abstract

BackgroundTargeting angiogenesis is nowadays one of the most promising approaches for breast cancer. Bevacizumab (BEV), a VEGF-trap monoclonal antibody, was recently approved in combination with paclitaxel (PAC) for the first line treatment of advanced breast cancer (ABC). The activity of this combination in pretreated patients is not known.MethodsPatients with pretreated ABC and progressive disease received BEV 10 mg/kg with PAC 135 mg/m2 every two weeks for six months and then maintenance with BEV 15 mg/kg every three weeks until progression. This regimen was chosen for better patient convenience, while maintaining the same dose intensity for both drugs.Results42 patients were reviewed retrospectively (41 f, 1 m, mean age 57 years). Overall response rate was 35.7%. Stable disease was observed in 45.2% of patients, whereas 14.3% of patients progressed. The median overall survival was greater than 20 months, with a one year rate of 83.4%. The median progression free survival was 12.1 months, with a one year rate of 51.8%. Toxicity was in general acceptable.ConclusionThis biweekly BEV/PAC combination seems to be active with acceptable toxicity in pretreated ABC with an advantage over the weekly regimen regarding quality of life and preservation of resources.

Salvage treatment in metastatic breast cancer with weekly paclitaxel and bevacizumab

“…The median duration of response (7.6 months), time to progression (4.8 months) and estimated survival (13.0 months) are not very different from the results reported with chemotherapy alone [19]. Similar results have also been reported by other investigators applying the same agents in a salvage regimen with some differences in regards to the intervals of paclitaxel administration (biweekly) and patient's characteristics since one third of them were HER2 positive [25]. The toxicity of the PB regimen in the present study was not severe, and with the exception of one patient with neutropenic sepsis that died, the rest of the patients recovered uneventfully from neutropenia treated with GCSF and oral antibiotics on an outpatient basis.…”

“…Interestingly, hypertension was not a significant problem in our study group. In several other studies, some patients suffered from cerebrovascular ischemia possibly related to treatment [10,11,[23][24][25].…”

“…The reported results from three large randomized studies [11,20,23] combining B with chemotherapy showed improvement in PFS but not OS, and this was also confirmed in a recently presented pooled analysis of these three studies [12] and has led to a more critical re-evaluation of the added therapeutic value of B in MBC. The role of B in pre-treated metastatic disease has been evaluated in a few studies [10,25,26] with no effect on overall survival. In the RIBBON-2 study, which evaluated the combination of B with various chemotherapies (taxane, gemcitabine, capecitabine, or vinorelbine) to treat MBC in the second line, the addition of B improved PFS of HER2-negative MBC patients with differing clinical characteristics and disease histories [26].…”

Paclitaxel and Bevacizumab Regimen for Metastatic Breast Cancer

“…PB is used to treat metastatic breast cancer ( Table 1 ). 1-10 PB has also been used in other advanced cancers such as ovarian, lung, and melanoma. 11-13…”

“…Because febrile neutropenia was reported in 0.3% to 8% of patients in the trials reviewed, 3-5,7,8 prophylactic use of colony stimulating factors is not recommended. Colony stimulating factors may be considered if a patient experiences febrile neutropenia or grade 4 neutropenia.…”