“Adding the EGFR inhibitor cetuximab (Erbitux) to chemotherapy failed to improve survival in patients with advanced non-small cell lung cancer, a multicenter randomized trial showed.
“The primary analysis showed a median overall survival of 10.9 months compared with 9.4 months, a difference that did not achieve statistical significance (HR 0.94, 95% CI 0.84-1.06). The trial also failed to demonstrate improvement in progression-free survival for patients with EGFR-positive disease, the co-primary endpoint.
“However, cetuximab led to a 25% reduction in hazard ratio among patients who had EGFR-positive tumors by fluorescence in situ hybridization (FISH) and were not candidates for bevacizumab (Avastin), a prespecified secondary endpoint. An exploratory analysis analysis showed that patients with EGFR-positive, squamous-cell tumors lived almost twice as long with cetuximab as with chemotherapy alone (11.8 vs 6.4 months, P=0.006), as reported here at the World Conference on Lung Cancer.”
“Biothera’s investigational cancer immunotherapy Imprime PGG in combination with standard platinum-based doublet chemotherapy and the monoclonal antibody bevacizumab achieved rapid and lasting responses in patients with non-squamous non-small cell lung cancer (NSCLC). Tumor reduction was observed regardless of tumor burden (up to > 30 cm) or location of lesions at baseline (including lung, lymph nodes, adrenals, liver). These findings were presented yesterday during a poster session at the annual meeting of the American Society of Clinical Oncology (abstract #3070).
“During Biothera’s randomized clinical study in non-squamous NSCLC, patients received four to six cycles of Imprime PGG in combination with bevacizumab and carboplatin/ paclitaxel chemotherapy. These treatment cycles were followed by a maintenance therapy phase consisting of bevacizumab with or without Imprime PGG.
“Overall, the objective response rate was 60.4% with Imprime PGG versus 43.5% in the control group. Time to response was short (12 weeks vs. > 16 weeks), and responses were durable with Imprime PGG (10.3 months vs. 5.6 months). In the maintenance phase, further meaningful tumor reductions were observed in 20% of patients in the Imprime PGG group, but none in the control group. These findings were associated with numerical increases in overall survival: at the 1-year mark (following treatment start) 62.8% of patients on Imprime PGG remained alive, compared with 42.7% of patients in the control group.”
“The combination of the investigational cancer immunotherapy Imprime PGG and the monoclonal antibody bevacizumab achieved additional meaningful reductions in tumor burden during the maintenance phase of Biothera’s recent phase 2 clinical trial in non-small cell lung cancer (NSCLC). The new data will be released today at the European Lung Cancer Conference.
“Biothera conducted a randomized Phase 2 clinical study in non-squamous NSCLC in which Imprime PGG was administered in combination with bevacizumab and platinum-based doublet chemotherapy. After four to six cycles of treatment, patients received maintenance therapy of bevacizumab with or without Imprime PGG. Further meaningful reductions in tumor burden (>10mm) were observed in 6 (20%) of patients in the Imprime PGG group, but not in the control group.
“ ‘Patients receiving the combination of Imprime PGG and bevacizumab experienced further reduction in their tumor burden than with bevacizumab therapy alone,’ said Ada Braun, M.D., Ph.D., Biothera Chief Medical Officer. ‘These results highlight the efficacy of Imprime PGG and show the potential for continued tumor regressions on chemotherapy-free maintenance therapy for some patients.’ ”
“A new survey of hospitals and academic medical centers finds that a recent move by Genentech to switch distribution of three widely used cancer treatments – Avastin, Rituxan and Herceptin – is resulting in higher costs, reduced access to the medications and delays in treating patients. And the institutions are hoping the results will prompt the drug maker, which says it’s unaware of such problems, to revert to its earlier distribution program.
“Here’s the background: Last fall, Genentech began using just a few distributors that specialize in handling such medicines. Until then, the Roche unit used dozens of wholesalers, although the specialty distributors are actually divisions of some of those same wholesalers. Genentech says the change was made to save money, but also make distribution more efficient and prevent the possibility of shortages.
“However, most of the institutions – 93% – say they had not experienced shortages, and the move has disrupted not only their finances, but patient care. The survey also found that 81% say the switch will have a moderate to significant impact on their expenses. Meanwhile, 63% say deliveries have been unreliable and 88% reported a delay in patient treatment because one of the drugs was unavailable.
“The institutions say they are forced to increase inventories to hedge against any supply disruptions that may occur because shipping can take longer, depending upon the location of the distributor. Some institutions say they cannot afford to keep large amounts of drug on hand, which can result in delays in treating new patients or unexpected events. And previous discounts may no longer be available.”
“The addition of bevacizumab did not prolong progression-free survival (PFS) or overall survival in postmenopausal women with HER2-negative, hormone receptor–positive advanced breast cancer treated with first-line endocrine therapy.
“The results of the Letrozole/Fulvestrant and Avastin (LEA) study were published in the Journal of Clinical Oncology.
“The median PFS was 14.4 months in the endocrine therapy arm and 19.3 months in the endocrine therapy plus bevacizumab arm (hazard ratio = 0.83; P = .126). The overall response rate was 22% and 41% in the control arm and the bevacizumab arm (P < .001). The duration of response was 13.3 months in the control arm compared with 17.6 months in the bevacizumab arm (P = .434). The time to treatment failure and overall survival were similar in both treatment arms.
“Study author Miguel Martín, MD, PhD, of Complutense University of Madrid told Cancer Network that there was a trend towards a better PFS in favor of the combination of bevacizumab and hormones. ‘Therefore, we cannot simply conclude that bevacizumab is ineffective in this setting.’ “
The gist: Women with basal-like triple-negative breast cancer (TNBC) might benefit from adding either the drug bevacizumab (Avastin) or the drug carboplatin to their chemotherapy treatment before tumor-removal surgery (neoadjuvant chemotherapy). For non-basal-like TNBC patients, carboplatin shows similar benefit, but bevacizumab may actually worsen their treatment response.
“A study of women with triple-negative breast cancer (TNBC) has shown that women with the basal-like subtype of breast cancer had higher rates of pathologic complete response (pCR) with the addition of bevacizumab (Avastin) to neoadjuvant chemotherapy than did women with non–basal-like breast cancer. No difference in response was seen between the two subtypes for the addition of carboplatin.
“These results were part of a subtype analysis of the CALGB/Alliance 40603 study and were presented at the 2014 San Antonio Breast Cancer Symposium, held December 9–13 in San Antonio, Texas, by William M. Sikov, MD, associate director of clinical research for the program in women’s oncology at Women and Infants Hospital and associate professor of medicine at Alpert Medical School of Brown University in Providence, Rhode Island.
“Earlier this year, results of the initial study of 443 women published in the Journal of Clinical Oncology showed that the addition of carboplatin or bevacizumab to neoadjuvant chemotherapy in women with stage II to III TNBC increased rates of pCR. In the subtype analysis, Sikov and colleagues sought to identify subgroups of patients who were more or less likely to benefit from the addition of these therapies.
“In a clinical trial involving women with triple-negative breast cancer, patients who received the drugs carboplatin and/or bevacizumab in combination with standard chemotherapy prior to surgery were more likely to have their tumors disappear entirely from the breast, according to data presented by investigators during the 2014 San Antonio Breast Cancer Symposium.
“Although bevacizumab doesn’t reduce long-term rates of cancer recurrence, the results raise hopes that carboplatin can be an important part of the fight against triple-negative cancer, say the leaders of the study, which was organized by the Alliance for Clinical Trials in Oncology with extensive involvement of physician/scientists at Dana-Farber Cancer Institute.
“The investigators analyzed data from 360 patients with triple-negative breast cancer, the vast majority of whom had a form of the disease known as basal-like tumors. Triple-negative cancer, named for its cells’ lack of three key receptors, accounts for about 15-20 percent of all breast cancers and tends to be aggressive, but can often be treated successfully if caught early. Basal-like tumors are made up of cells that resemble the basal cells lining the milk ducts.
“In the trial, patients with triple-negative breast cancer were treated with ‘neoadjuvant” chemotherapy’ — which helps shrink tumors so they can be surgically removed — either alone or in combination with bevacizumab or carboplatin or both. (Bevacizumab prevents tumors from developing networks of blood vessels; carboplatin is a platinum-based chemotherapy agent.)”
The gist: A recent clinical trial found that positron emission tomography (PET) scans could be used to predict how well a patient will respond to neoadjuvant (pre-surgery) treatment with chemotherapy and trastuzumab (Herceptin). Doctors might recommend a change in treatment to a patient whose PET scans show that current treatment isn’t working. In the study, researchers treated women with early-stage, HER2-positive breast cancer. Based on PET scans, the researchers were able to predict which patients would still have signs of an invasive tumor after treatment. They also found that adding the drug bevacizumab (Avastin) to the treatment plan could improve responses for some of these patients.
Editor’s note: This article describes the results of a clinical trial—a research study with volunteer patients. The goal of the trial was to compare two different treatment approaches for non-squamous non-small cell lung cancer (NSCLC) with mutations in the EGFR gene. One treatment combined the drugs erlotinib and bevacizumab, and the other treatment was simply erlotinib alone. Based on the results, the researchers say that erlotinib plus bevacizumab could be a new standard treatment for people with NSCLC with EGFR mutations.
“The authors aimed to compare the efficacy and safety of the combination of erlotinib and bevacizumab compared with erlotinib alone in patients with non–squamous NSCLC with activating EGFR mutation–positive disease. Erlotinib plus bevacizumab combination could be a new first–line regimen in EGFR mutation–positive NSCLC. Further investigation of the regimen is warranted.”