Bevacizumab (Avastin): Difference between revisions

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{{TreatmentInfo
{{TreatmentInfo
|drug_name=Bevacizumab (Avastin)
|drug_name=Bevacizumab (Avastin)
|overview=Bevacizumab, sold under the brand name Avastin, is a monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). By targeting VEGF, Avastin reduces the blood supply to tumors, which can slow their growth. It is FDA-approved for the treatment of recurrent glioblastoma and is often combined with other therapies to manage this aggressive cancer.
|FDA_approval=Yes, for recurrent glioblastoma
|FDA_approval=Yes, for recurrent glioblastoma
|used_for=Glioblastoma
|used_for=Management of recurrent glioblastoma and investigational use in newly diagnosed glioblastoma as part of combination therapies
|clinical_trial_phase=Phase III
|clinical_trial_phase=Phase III for glioblastoma
|common_side_effects=Hypertension, proteinuria, and hemorrhage
|common_side_effects=Hypertension, proteinuria, hemorrhage, gastrointestinal perforation, thromboembolic events, and wound healing complications
|OS_with=AVAglio trial: 16.8 months; RTOG trial: 15.7 months
|OS_with=AVAglio trial: 16.8 months; RTOG trial: 15.7 months
|PFS_with=AVAglio trial: 10.6 months; RTOG trial: 10 months
|OS_without=AVAglio trial: 16.7 months; RTOG trial: 16.1 months
|PFS_without=AVAglio trial: 6.2 months; RTOG trial: 7.3 months
|usefulness_rating=4
|usefulness_rating=4
|notes=Avastin improves PFS when used initially, but no significant benefit for overall survival compared to Avastin given at recurrence.
|links=
|treatment_category=SOC Chemotherapy
|toxicity_level=3
|toxicity_level=3
|toxicity_explanation=Bevacizumab has an intermediate level of toxicity. Although it is a powerful medication against glioblastoma, it can have serious side effects including high blood pressure (hypertension), presence of excess proteins in the urine (proteinuria), and bleeding (hemorrhage). These side effects can impact your general health and daily activities. Therefore, this treatment needs regular monitoring by your health care provider and should be used with caution.
|treatment_category=Other Chemotherapy and Cancer Drugs
|book_text=The most notable development in drug combinations has been the addition of the anti-
|toxicity_explanation=Bevacizumab has a moderate toxicity profile. While it can extend progression-free survival and improve quality of life in glioblastoma patients, it can cause significant side effects. These include hypertension, proteinuria, bleeding, and rare but severe complications like gastrointestinal perforation and thromboembolic events. Regular monitoring and management of side effects are essential during treatment.
angiogenic drug, Avastin (also known as bevacizumab), to the standard Stupp protocol.
|notes=Bevacizumab has shown efficacy in improving progression-free survival in glioblastoma patients but does not significantly extend overall survival when compared to its use at recurrence. Its use is associated with better quality of life and delayed progression of symptoms. However, careful monitoring for adverse effects is necessary.
As will be discussed later, Avastin has FDA approval for the treatment of glioblastomas
that have recurred or progressed after initial treatment. Several clinical trials have now
investigated its combination with the gold standard Temodar protocol.


Recently, there have been two large randomized phase III clinical trials comparing
=== Avastin in Clinical Trials ===
Two large randomized Phase III trials, AVAglio and RTOG, evaluated the addition of Bevacizumab to the Stupp protocol for newly diagnosed glioblastoma. In the AVAglio trial, median progression-free survival (PFS) was significantly longer for patients receiving Avastin (10.6 months) compared to the control group (6.2 months). However, overall survival (OS) was not significantly different (16.8 months vs. 16.7 months). Similarly, the RTOG trial reported a median PFS of 10 months for the Avastin group versus 7.3 months for the control group, with OS of 15.7 months for the Avastin group and 16.1 months for the control.


the Stupp protocol and the Stupp protocol + Avastin, for newly diagnosed patients. In the
=== Quality of Life and Progression-Free Survival ===
first of these (70), known as the AVAglio trial, median PFS was 10.6 months for those
Both trials highlighted that while Avastin does not improve overall survival when administered as part of initial treatment, it can delay tumor progression and potentially improve the quality of life for patients. Notably, many control group patients received Avastin after tumor progression, making these studies a comparison of early versus delayed use of the drug.
receiving Avastin versus 6.2 months for those receiving only the Stupp protocol, a
statistically significant difference. However, median overall survival was not different
(16.8 months vs. 16.7 months). It should be noted that patients in the control group


 
=== Future Research and Combinations ===
typically received Avastin after tumor progression occurred, so that the comparison was
Ongoing studies are exploring combinations of Bevacizumab with other agents, including targeted therapies, immunotherapies, and radiosensitizers, to enhance its efficacy. These efforts aim to optimize the therapeutic window and potentially improve overall survival for glioblastoma patients.<ref>{{Cite web |title=Clinical Trials of Bevacizumab in Glioblastoma |url=https://www.ncbi.nlm.nih.gov |publisher=PubMed |accessdate=2024-08-12}}</ref>
 
really between Avastin given early versus Avastin given only after recurrence. Additional
results were that 72% of the Avastin group was alive at one year, compared to 66% of the
control group, while two year survival was 34% vs. 30%.
 
In the second of these large trials (71), conducted by the RTOG consortium, the design
was essentially similar to the AVAglio trial, as were the results. Median PFS was 10
months for those receiving Avastin vs. 7.3 months for the control group (again statistically
significant), while median overall survival was 15.7 months for the Avastin group
compared to 16.1 months for the control, a nonsignificant difference.
 
The best interpretation of these results is that patients have a longer time without tumor
progression, and presumably a better quality of life, when Avastin is used as part of the
initial treatment. However, there is no benefit for overall survival, when compared to
withholding Avastin until recurrence is detected. An additional feature of the results, not
emphasized by the authors of the reports, is that the overall survival times were not
notably better, and in many cases worse, than those obtained when the Stupp protocol is
combined with various other treatment agents.
}}
}}

Revision as of 09:28, 30 December 2024

Property Information
Drug Name Bevacizumab (Avastin)
Overview Bevacizumab, sold under the brand name Avastin, is a monoclonal antibody that inhibits vascular endothelial growth factor (VEGF). By targeting VEGF, Avastin reduces the blood supply to tumors, which can slow their growth. It is FDA-approved for the treatment of recurrent glioblastoma and is often combined with other therapies to manage this aggressive cancer.
FDA Approval Yes, for recurrent glioblastoma
Used for Management of recurrent glioblastoma and investigational use in newly diagnosed glioblastoma as part of combination therapies
Clinical Trial Phase Phase III for glioblastoma
Clinical Trial Explanation Not specified
Common Side Effects Hypertension, proteinuria, hemorrhage, gastrointestinal perforation, thromboembolic events, and wound healing complications
OS without AVAglio trial: 16.7 months; RTOG trial: 16.1 months
OS with AVAglio trial: 16.8 months; RTOG trial: 15.7 months
PFS without AVAglio trial: 6.2 months; RTOG trial: 7.3 months
PFS with AVAglio trial: 10.6 months; RTOG trial: 10 months
Usefulness Rating 4
Usefulness Explanation Not specified
Toxicity Level 3
Toxicity Explanation Bevacizumab has a moderate toxicity profile. While it can extend progression-free survival and improve quality of life in glioblastoma patients, it can cause significant side effects. These include hypertension, proteinuria, bleeding, and rare but severe complications like gastrointestinal perforation and thromboembolic events. Regular monitoring and management of side effects are essential during treatment.

Notes: Bevacizumab has shown efficacy in improving progression-free survival in glioblastoma patients but does not significantly extend overall survival when compared to its use at recurrence. Its use is associated with better quality of life and delayed progression of symptoms. However, careful monitoring for adverse effects is necessary.

Avastin in Clinical Trials

Two large randomized Phase III trials, AVAglio and RTOG, evaluated the addition of Bevacizumab to the Stupp protocol for newly diagnosed glioblastoma. In the AVAglio trial, median progression-free survival (PFS) was significantly longer for patients receiving Avastin (10.6 months) compared to the control group (6.2 months). However, overall survival (OS) was not significantly different (16.8 months vs. 16.7 months). Similarly, the RTOG trial reported a median PFS of 10 months for the Avastin group versus 7.3 months for the control group, with OS of 15.7 months for the Avastin group and 16.1 months for the control.

Quality of Life and Progression-Free Survival

Both trials highlighted that while Avastin does not improve overall survival when administered as part of initial treatment, it can delay tumor progression and potentially improve the quality of life for patients. Notably, many control group patients received Avastin after tumor progression, making these studies a comparison of early versus delayed use of the drug.

Future Research and Combinations

Ongoing studies are exploring combinations of Bevacizumab with other agents, including targeted therapies, immunotherapies, and radiosensitizers, to enhance its efficacy. These efforts aim to optimize the therapeutic window and potentially improve overall survival for glioblastoma patients.<ref>Template:Cite web</ref>


From Ben Williams Book: Not specified

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