According to the results of a Phase II clinical trial, the combination of two targeted therapies-Avastin® (bevacizumab) and Tarceva® (erlotinib)-has anticancer activity in patients with advanced hepatocellular (liver) cancer and warrants further study. These results were published in the Journal of Clinical Oncology.
Hepatocellular carcinoma is the most common type of primary liver cancer (cancer that begins in the liver). Factors that increase the risk of developing hepatocellular carcinoma include long-term, heavy alcohol use and chronic infection with hepatitis B or C viruses.
Until recently, there were few effective treatment options for patients with advanced hepatocellular carcinoma. In 2007, however, results from a Phase III clinical trial indicated that the targeted therapy Nexavar® (sorafenib) prolonged survival among patients with advanced hepatocellular carcinoma. Other targeted therapies may also provide a benefit and are currently being evaluated in clinical trials.
Avastin is a targeted anticancer drug that slows or prevents the growth of new blood vessels by inhibiting a protein known as VEGF; this deprives the cancer of oxygen and nutrients. Through its effects on blood vessels, Avastin may also improve the delivery of chemotherapy to cancer. Avastin has been shown to improve treatment outcomes in selected patients with advanced colorectal, breast, and non–small cell lung cancer. Avastin is also being evaluated among patients with earlier-stage cancer, and among patients with other types of cancer.
Tarceva is targeted anticancer drug that works by blocking a biological pathway referred to as the epidermal growth factor receptor (EGFR) pathway. The EGFR pathway is involved in cell growth and replication and when mutated or altered, excessive replication of cells can occur. Tarceva has been shown to improve treatment outcomes in selected patients with advanced non–small cell lung cancer or pancreatic cancer, and is also being evaluated in the treatment of other types of cancer.
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To evaluate the combination of Avastin and Tarceva among patients with advanced hepatocellular carcinoma, researchers conducted a Phase II clinical trial. The study enrolled 40 patients who were not candidates for surgical treatment or regional therapies such as chemoembolization.
- 63% of patients remained free of cancer progression for at least 16 weeks.
- Median overall survival was 15.6 months.
- Serious adverse effects of treatment included fatigue, hypertension, diarrhea, elevated liver enzymes, and gastrointestinal bleeding.
This study suggests that the combination of Avastin and Tarceva has anticancer activity in patients with advanced hepatocellular carcinoma. The researchers recommend additional evaluation of this treatment combination.
 Llovet J, et al. Sorafenib improves survival in advanced Hepatocellular Carcinoma (HCC): Results of a Phase III randomized placebo-controlled trial (SHARP trial). Proceedings from the 2007 annual meeting of the American Society of Clinical Oncology. Late-breaking Abstract (LBA) #1.
 Thomas MB, Morris JS, Chadha R et al. Phase II trial of the combination of bevacizumab and erlotinib in patients who have advanced hepatocellular carcinoma. Journal of Clinical Oncology [early online publication]. January 12, 2009.