According to an article recently published in the Journal of Clinical Oncology, the addition of the targeted agent Avastin® (bevacizumab) to treatment including the targeted agent Erbitux® (cetuximab), with or without the chemotherapy agent Camptosar® (irinotecan), appears effective for patients with advanced colorectal cancer who do not respond to Camptosar alone.

Colorectal cancer remains the second leading cause of cancer-related deaths in the United States. Advanced colorectal cancer refers to cancer that has spread from its site of origin to distant sites in the body, often invading vital organs. Camptosar is a commonly used chemotherapy agent for the treatment of advanced colorectal cancer. However, some patients either do not respond to initial therapy with Camptosar or eventually stop responding.

Erbitux is a targeted agent that slows or prevents the growth or spread of some cancers. Erbitux targets and binds to a specific protein, the epidermal growth factor receptor (EGFR), which is a component of biologic pathways involved in growth and spread of cells. The addition of Erbitux to Camptosar has demonstrated effectiveness among patients who do not respond to Camptosar alone.

Avastin is also a targeted agent that slows or prevents the growth or spread of some cancers by targeting the vascular endothelial growth factor receptor (VEGF), which is involved in supplying blood vessels to cancer cells. The blood vessels carry oxygen and nutrients to the cancer cells, allowing for their growth and spread.

Because Erbitux and Avastin target different pathways in cellular growth, it is thought that the combination may increase anticancer activity over either agent alone.

Researchers from Memorial Sloan Kettering Cancer Center (MSKCC) recently conducted a clinical trial to evaluate Erbitux in the treatment of colorectal cancer patients with liver metastases. This trial included 83 patients with advanced colorectal cancer who did not respond to treatment with Camptosar alone. No patients had received prior therapy with Erbitux or Avastin. One group of patients was treated with Erbitux/Avastin/Camptosar, and the other group was treated with Erbitux and Avastin.

  • Time to cancer progression was 7.3 months for patients treated with Erbitux/Avastin/Camptosar versus 4.9 months for those treated with Erbitux/Avastin.
  • Anticancer responses were achieved in 37% of patients treated with Erbitux/Avastin/Camptosar versus 20% for those treated with Erbitux/Avastin.
  • Overall survival was 14.5 months for patients treated with Erbitux/Avastin/Camptosar compared with 11.4 months for those treated with Erbitux/Avastin.

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The researchers concluded that, when compared to historical data including Erbitux alone, the addition of Avastin to Erbitux plus Camptosar or to Erbitux alone appears to enhance effectiveness in the treatment of advanced colorectal cancer among patients who do not respond to Camptosar. As well, the addition of Camptosar to Avastin and Erbitux appears to provide improved anticancer activity over that of Avastin and Erbitux alone.

Patients with advanced colorectal cancer may wish to speak with their physician about their individual risks and benefits of treatment with the addition of Avastin. Patients may also want to discuss with their physician the participation in a clinical trial further evaluating this or other novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov) and www.eCancerTrials.com.

Reference: Saltz L, Lenz H-J, Kindler H, et al. Randomized Phase II trial of cetuximab, bevacizumab, and irinotecan compared with cetuximab and bevacizumab alone in irinotecan-refractory colorectal cancer: The BOND-2 Study. Journal of Clinical Oncology. 2007;25:4557-4561.

Related News:Erbitux® Improves Outcomes in Advanced Colorectal Cancer (04/26/2007)

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