Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast Cancer

• Published in: The New England journal of medicine Vol. 357; no. 26; pp. 2666 - 2676
• Main Authors: Miller, Kathy, Wang, Molin, Gralow, Julie, Dickler, Maura, Cobleigh, Melody, Perez, Edith A, Shenkier, Tamara, Cella, David, Davidson, Nancy E
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27.12.2007
• Subjects: Adult; Aged; Aged, 80 and over; Angiogenesis; Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Anticoagulants; Antineoplastic Agents, Phytogenic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Cancer therapies; Cytotoxicity; Disease Progression; Female; Gene amplification; General aspects; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Middle Aged; Neoplasm Metastasis - drug therapy; Paclitaxel - adverse effects; Paclitaxel - therapeutic use; Proportional Hazards Models; Quality of Life; Receptor, ErbB-2 - analysis; Survival Analysis; Tumors; Vascular endothelial growth factor; Antineoplastic agent; Drug combination; Breast cancer; Monoclonal antibody; Metastasis; Malignant tumor; Bevacizumab; Immunomodulator; Medicine; Mammary gland diseases; Vascular endothelium growth factor; Taxane derivatives; Paclitaxel; Advanced stage; Metastatic; Antagonist; Mammary gland; Antiangiogenic agent; Antimitotic; Comparative study; Cancer
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMoa072113

This trial tested the effect of adding bevacizumab, a monoclonal antibody against vascular endothelial growth factor A, to the taxane paclitaxel for the initial treatment of metastatic breast cancer. As compared with paclitaxel alone, the combination increased progression-free survival but not overall survival. The results are a demonstration of the potential benefit of antiangiogenic treatment for breast cancer. This trial tested the effect of adding bevacizumab, a monoclonal antibody against vascular endothelial growth factor A, to paclitaxel for the initial treatment of metastatic breast cancer. As compared with paclitaxel alone, the combination increased progression-free survival but not overall survival. Laboratory and clinical evidence supports the central role of angiogenesis in the progression of breast cancer. 1 , 2 Multiple angiogenic factors are commonly expressed by invasive breast cancers; the 121-amino-acid isoform of vascular endothelial growth factor (VEGF) predominates. 3 VEGF stimulates endothelial proliferation and migration, inhibits endothelial apoptosis, induces proteinases that remodel the extracellular matrix, increases vascular permeability and vasodilatation, and inhibits antigen-presenting dendritic cells. 4 Differences in function among the various VEGF isoforms are not well defined, though VEGF-C has a predominant role in lymphangiogenesis, whereas VEGF-A is more potent in inducing vasodilatation and pathologic angiogenesis. 5 , 6 Bevacizumab (Avastin, Genentech) is a . . .