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The impact of bevacizumab in metastatic colorectal cancer with an intact primary tumor: Results from a large prospective cohort study
Author(s) -
Lee Belinda,
Wong HuiLi,
Tacey Mark,
Tie Jeanne,
Wong Rachel,
Lee Margaret,
Nott Louise,
Shapiro Jeremy,
Jennens Ross,
Turner Natalie,
Tran Ben,
Ananda Sumitra,
Yip Desmond,
Richardson Gary,
Parente Phillip,
Lim Lionel,
Stefanou Greg,
Burge Matthew,
Iddawela Mahesh,
Power Jeremy,
Gibbs Peter
Publication year - 2017
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12639
Subject(s) - bevacizumab , medicine , colorectal cancer , asymptomatic , chemotherapy , oncology , primary tumor , surgery , cancer , gastroenterology , metastasis
Background Debate continues regarding the benefits versus risks of initial resection of the primary tumor in metastatic colorectal cancer (mCRC) patients with an asymptomatic primary tumor. Although the benefit of the anti‐vascular endothelial growth factor agent bevacizumab alongside first‐line chemotherapy in mCRC is established, the impact of bevacizumab on the intact primary tumor (IPT) is less well understood. Methods Data from an Australian mCRC registry were used to assess the impact of bevacizumab‐based regimens in the presence of an IPT, to see if this differs from effects in resected primary tumor (RPT) patients and to understand the safety profile of bevacizumab in patients with IPT. Progression‐free survival (PFS), overall survival (OS) and safety endpoints were analyzed. Results Of 1204 mCRC patients, 826 (69%) were eligible for inclusion. Bevacizumab use was similar in both arms (IPT (64%) versus RPT (70%)); compared with chemotherapy alone, bevacizumab use was associated with significantly longer PFS (IPT: 8.5 months vs 4.7 months, P = 0.017; RPT: 10.8 months vs 5.8 months, P < 0.001) and OS (IPT: 20 months vs 14.8 months, P = 0.005; RPT: 24.4 months vs 17.3 months, P = 0.004)). 1 Bevacizumab use in an IPT was associated with more GI perforations (4.5% vs 1.8%, P = 0.210) but less frequent bleeding (1.5% vs 5.3%, P = 0.050) and thrombosis (1.5% vs 2.7%, P = 0.470), versus chemotherapy alone. Median survival was equivalent between patients that did or did not experience bevacizumab‐related adverse events – 20.0 months versus 19.9 months, hazard ratio = 0.98, P = 0.623. 1Conclusions The addition of bevacizumab significantly improved survival outcomes in mCRC with an IPT. The occurrence of bevacizumab‐related adverse events did not significantly impact survival outcomes.