Avastin Chemotherapy in the Treatment of Mesothelioma
Avastin Chemotherapy in the Treatment of Mesothelioma
Mesothelioma is a rare and aggressive cancer that affects the lining of the lungs, chest, abdomen, or heart. Mesothelioma is mainly caused by exposure to asbestos, a mineral fiber that was widely used in construction, insulation, and manufacturing industries. Mesothelioma has a poor prognosis, with a median survival of less than one year after diagnosis. Chemotherapy is the standard treatment for mesothelioma, but it has limited effectiveness and causes significant side effects. Therefore, there is an urgent need for new and better therapies for mesothelioma.
Avastin (bevacizumab) is a biological agent that has shown promising results in the treatment of mesothelioma. Avastin is an antibody that binds to and blocks vascular endothelial growth factor (VEGF), a protein that stimulates the growth of new blood vessels. By inhibiting VEGF, Avastin prevents the formation of blood vessels that supply oxygen and nutrients to the tumor, thus slowing down its growth and spread. Avastin is approved by the U.S. Food and Drug Administration (FDA) for the treatment of several types of cancer, such as colorectal, lung, kidney, cervical, and ovarian cancers. However, Avastin is not yet approved for mesothelioma.
How is Avastin used for mesothelioma?
Avastin is used in combination with chemotherapy drugs for mesothelioma. The most common chemotherapy regimen for mesothelioma consists of cisplatin and pemetrexed (Alimta), two drugs that kill cancer cells by interfering with their DNA synthesis and repair. Avastin is added to this regimen to enhance its efficacy and overcome resistance. Avastin is given intravenously every three weeks, while cisplatin and pemetrexed are given every three or four weeks.
What are the benefits of Avastin for mesothelioma?
The benefits of Avastin for mesothelioma have been demonstrated in several clinical trials. The most important one is the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS), a randomized, controlled, open-label, phase 3 trial that involved 448 patients with unresectable malignant pleural mesothelioma who had not received previous chemotherapy. The patients were assigned to receive either cisplatin and pemetrexed with or without Avastin. The results showed that adding Avastin to cisplatin and pemetrexed significantly improved overall survival (the primary endpoint), progression-free survival, and response rate compared with cisplatin and pemetrexed alone. The median overall survival was 18.8 months in the Avastin group versus 16.1 months in the control group (hazard ratio 0.77; p=0.0167). The median progression-free survival was 9.2 months in the Avastin group versus 7.3 months in the control group (hazard ratio 0.61; p<0.0001). The response rate was 44.8% in the Avastin group versus 27.8% in the control group (p=0.002). These results suggest that Avastin is the first drug to improve survival in mesothelioma patients since pemetrexed was approved in 2004.
What are the side effects of Avastin for mesothelioma?
The side effects of Avastin for mesothelioma are similar to those observed in other types of cancer. The most common side effects are low blood cell counts, nausea, vomiting, fatigue, loss of appetite, diarrhea, constipation, mouth sores, hair loss, headache, and high blood pressure. The most serious side effects are bleeding, blood clots, perforation of the gastrointestinal tract, wound healing complications, kidney damage, heart failure, and reversible posterior leukoencephalopathy syndrome (a neurological disorder). The incidence and severity of side effects depend on the dose and duration of Avastin treatment, as well as on the patient's age, health status, and other medications.
Conclusion
Avastin is a novel biological agent that has shown promising results in the treatment of mesothelioma when combined with chemotherapy drugs cisplatin and pemetrexed. Avastin works by blocking VEGF, a protein that stimulates the growth of new blood vessels that feed the tumor. Avastin can improve the survival, progression-free survival, and response rate of mesothelioma patients compared with chemotherapy alone. Avastin can also cause side effects that affect different parts of the body. Patients should be aware of the benefits and risks of Avastin and discuss them with their doctor before starting treatment.
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: Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. Lancet. 2016;387(10026):1405-1414. DOI: 10.1016/S0140-6736(15)01238-6.