Bevacizumab and Perioperative Chemotherapy for Esophago-gastric Cancers

Bevacizumab is not recommended in conjunction with perioperative chemotherapy for patients with resectable gastric, esophagogastric junction, or lower esophageal adenocarcinoma, according to a study published in The Lancet Oncology.¹

Perioperative chemotherapy consisting of epirubicin, cisplatin, and capecitabine improves clinical outcomes for patients with esophago-gastric cancers, though the 5-year survival rate in this patient population is still 40%. For this phase 2/3 study (ClinicalTrials.gov Identifier: NCT00450203), researchers enrolled 1063 patients to determine the safety and efficacy of adding bevacizumab, which can improve patient responses to chemotherapy, to the perioperative combination.

After random assignment, 530 patients received bevacizumab plus chemotherapy and 533 patients received chemotherapy alone. Adding bevacizumab did not improve 3-year the overall survival rate (48.1%) vs chemotherapy alone (50.3%); progression events were similar in both groups. There were not enough data to determine 5-year overall survival rates.

Adverse events were similar in both groups and were uncommon with the exception of neutropenia. There was evidence that bevacizumab prevented surgical wounds from healing; the addition also appeared to increase the likelihood of post-operative anastomotic leak.

Reasons for this study’s failure were not discussed in depth.

The authors concluded that bevacizumab should not be added to perioperative chemotherapy for patients with esophago-gastric cancers. Other novel therapies should be evaluated.

Reference

1. Cunningham D, Stenning SP, Smyth EC, et al. Peri-operative chemotherapy with or without bevacizumab in operable oesophagogastric adenocarcinoma (UK Medical Research Council ST03): primary analysis results of a multicentre, open-label, randomised phase 2–3 trial. Lancet Oncol. 2017 Feb 2. doi: 10.1016/S1470-2045(17)30043-8 [Epub ahead of print]