Avastin (bevacizumab) is beneficial in multiple colorectal cancer subgroups and treatment settings

What's exciting about Avastin?

Avastin (bevacizumab) targets VEGF-A, a growth factor protein that functions in pathways important for new blood vessel growth thereby functioning as an anti-angiogenesis drug.

A number of benefits have been reported for the use Avastin in advanced colorectal cancer. Data from a study of patients with metastatic colorectal cancer receiving first-line Avastin or Erbitux plus chemotherapy found that progression free survival was higher for Avastin-containing combinations (Vargas CA, et al. 2014). Clinical studies have additionally demonstrated that overall survival and progression free survival are improved with continuation of Avastin plus chemotherapy after first-line progression (Michalaki V, et al. 2014, Ocvirk J, et al. 2014, Arnold D, et al. 2012).

A retrospective study reported significantly longer overall survival and progression free survival in patients with KRAS wild type colorectal cancer compared to KRAS-mutant colorectal cancer treated with Avastin (Petrelli F, et al. 2013). Other studies however, have found no association between KRAS mutation status and outcome measures in Avastin-treated colorectal cancer patients (Loupakis, et al. 2014, Kim ST, et al. 2014, Kubicka S, et al. 2013, Selcukbiricik F, et al. 2013). A trend toward larger benefit for patients with BRAF-mutant colorectal cancer treated with Avastin plus FOLFOXIRI was observed though limited by small subgroup size (Loupakis, et al. 2014).

What side effects are associated with Avastin?

Common side effects include epistaxis, headache, hypertension, rhinitis, proteinuria, taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, back pain and exfoliative dermatitis. Less common but serious side effects include gastrointestinal perforation, wound healing complications, and severe or fatal hemorrhage (see the FDA drug label).

How can my patient get access to Avastin?

Avastin is FDA approved for metastatic colorectal cancer with intravenous 5-FU based chemotherapy for first- or second line treatment, including for patients who have progressed on a first-line Avastin-containing regimen (see the FDA drug label). Additionally, ongoing clinical trials are testing the safety and efficacy of other Avastin containing combinations. See the trials table.

 References

Summary

Name(s) Target Manufacturer Status
Avastin, bevacizumab VEGFA Genentech FDA approved for: Glioblastoma Multiforme, Colorectal Cancer, Renal Cell Carcinoma, Non-Small Cell Lung Cancer

Clinical Trials

Trial Drug Status Phase
Combination Chemotherapy Plus Bevacizumab With or Without Oxaliplatin in Treating Older Patients With Metastatic Colorectal Cancer [NCT01279681] Avastin, Eloxatin, Fluorouracil, Xeloda, leucovorin Not yet recruiting Phase 3
FOLFOX6m Plus SIR-Spheres Microspheres vs FOLFOX6m Alone in Patients With Liver Mets From Primary Colorectal Cancer [NCT01721954] Avastin, Eloxatin, Fluorouracil, leucovorin Recruiting Phase 3
Bevacizumab in Pats w/ Recurrent ST Brain Metas Who Have Failed Whole Brain Radiation Therapy [NCT01898130] Avastin Recruiting Phase 2
A Study Comparing the Efficacy and Safety of RO5520985 and FOLFOX With Bevacizumab and FOLFOX in Patients With Untreated Metastatic Colorectal Cancer (McCAVE) [NCT02141295] Avastin, Eloxatin, Fluorouracil, RO5520985, leucovorin Recruiting Phase 2
Bevacizumab, Fluorouracil, Leucovorin Calcium, and Oxaliplatin Before Surgery in Treating Patients With Stage II-III Rectal Cancer [NCT01871571] Avastin, Eloxatin, Fluorouracil, leucovorin Recruiting Phase 2
Genotype-Directed Study Of Irinotecan Dosing In FOLFIRI + BevacizumabTreated Metastatic Colorectal Cancer [NCT02138617] Avastin, Camptosar, Fluorouracil, leucovorin Not yet recruiting Phase 2
Levocetirizine + Capecitabine + Bevacizumab for Patients With Refractory Colorectal Cancer [NCT01722162] Avastin, Levocetirizine dihydrochloride, Xeloda Recruiting Phase 2
Hydroxychloroquine, Capecitabine, Oxaliplatin, and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer [NCT01006369] Avastin, Eloxatin, Fluorouracil, Hydroxychloroquine Sulfate, Xeloda, leucovorin Recruiting Phase 2
STEAM: A Study of Sequential and Concurrent FOLFOXIRI/Avastin (Bevacizumab) Regimens Versus FOLFOX/Avastin in First-Line in Patients With Metastatic Colorectal Cancer [NCT01765582] Avastin, Camptosar, Eloxatin, Fluorouracil, leucovorin Recruiting Phase 2
DCE-MRI PET Bevacizumab Study in Rectal Cancer [NCT01426074] Avastin, Eloxatin, Fluorouracil, leucovorin Recruiting Phase 2
Study of Vitamin D in Untreated Metastatic Colorectal Cancer [NCT01516216] Avastin, Eloxatin, Ergocalciferol, Fluorouracil, leucovorin Recruiting Phase 2
Combination of BKM120 and Bevacizumab in Refractory Solid Tumors and Relapsed/Refractory Glioblastoma Multiforme [NCT01349660] Avastin, buparlisib Recruiting Phase 1/Phase 2
FOLFOX/Bevacizumab/Hydroxychloroquine (HCQ) in Colorectal Cancer [NCT01206530] Avastin, Eloxatin, Fluorouracil, Hydroxychloroquine Sulfate, leucovorin Recruiting Phase 1/Phase 2
A Study Of PF-05212384 Plus FOLFIRI Versus Bevacizumab Plus FOLFIRI In Metastatic Colorectal Cancer [NCT01937715] Avastin, Camptosar, Fluorouracil, PF-05212384, leucovorin Recruiting Phase 1/Phase 2
Genistein in Treatment of Metastatic Colorectal Cancer [NCT01985763] Avastin, Eloxatin, Fluorouracil, genistein, leucovorin Recruiting Phase 1/Phase 2
RAD001, FOLFOX and Bevacizumab in Treatment of Colorectal Carcinoma [NCT01047293] Afinitor, Avastin, Eloxatin, Fluorouracil, leucovorin Recruiting Phase 1/Phase 2
A Study to Evaluate the Safety and Antitumor Activity in Subjects With Advanced Solid Tumors [NCT01248949] Avastin, Carboplatin, Gemzar, MEDI3617, Taxol Recruiting Phase 1
MLN0128 and Bevacizumab in Treating Patients With Recurrent Glioblastoma or Advanced Solid Tumors [NCT02142803] Avastin, MLN0128 Recruiting Phase 1
A Phase 1/1b Study With ABBV-399, an Antibody Drug Conjugate, in Subjects With Advanced Solid Cancer Tumors [NCT02099058] ABBV-399, Avastin, Carboplatin, Erbitux, Tarceva Recruiting Phase 1
Study of REOLYSIN® in Combination With FOLFIRI and Bevacizumab in FOLFIRI Naive Patients With KRAS Mutant Metastatic Colorectal Cancer [NCT01274624] Avastin, Camptosar, Fluorouracil, REOLYSIN, leucovorin Recruiting Phase 1
Biweekly Intraperitoneal Oxaliplatin With Systemic Capecitabine and Bevacizumab for Patients With Peritoneal Carcinomatosis From Appendiceal or Colorectal Cancer [NCT01061515] Avastin, Eloxatin, Xeloda Recruiting Phase 1
Tivantinib and Bevacizumab in Treating Patients With Solid Tumors That Are Metastatic or Cannot Be Removed By Surgery [NCT01749384] ARQ 197, Avastin Recruiting Phase 1
A Phase 1b Study of MPDL3280A (an Engineered Anti-PDL1 Antibody) in Combination With Avastin (Bevacizumab) and/or With Chemotherapy in Patients With Locally Advanced or Metastatic Solid Tumors [NCT01633970] Abraxane, Alimta, Avastin, Carboplatin, Eloxatin, Fluorouracil, MPDL3280A, Taxol, leucovorin Recruiting Phase 1
Nab-paclitaxel, Gemcitabine, and Bevacizumab in Advanced Malignancies [NCT01113476] Abraxane, Avastin, Gemzar Recruiting Phase 1
Dasatinib in Combination With Bevacizumab to Treat Advanced Solid Tumors [NCT01445509] Avastin, Sprycel Recruiting Phase 1
Avastin/Torisel With Carboplatin, Taxol, or Sorafenib [NCT01187199] Avastin, Carboplatin, Nexavar, Taxol, Torisel Recruiting Phase 1
Dasatinib, Bevacizumab, Paclitaxel in Patients With Advanced Malignancies [NCT01015222] Avastin, Relistor, Sprycel, Taxol Recruiting Phase 1
Bevacizumab, Temsirolimus, Valproic Acid, Cetuximab [NCT01552434] Avastin, Erbitux, Torisel, Valproic acid Recruiting Phase 1
Hepatic Arterial Infusion Oxaliplatin, Capecitabine With or Without Bevacizumab [NCT01213238] Avastin, Eloxatin, Xeloda Recruiting Phase 1
Doxil, Bevacizumab and Temsirolimus Trial [NCT00761644] Afinitor, Avastin, Doxil, Torisel Recruiting Phase 1
A Study of BBI608 in Combination With Standard Chemotherapies in Adult Patients With Advanced Gastrointestinal Cancer [NCT02024607] Avastin, BBI-608, Camptosar, Eloxatin, Fluorouracil, Stivarga, Xeloda, leucovorin Recruiting Phase 1
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