Annals of Oncology Advance Access originally published online on April 30, 2009
Annals of Oncology 2009 20(11):1842-1847; doi:10.1093/annonc/mdp233
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gastrointestinal tumors |
Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study
1 Digestive Oncology Unit, University Hospital Gasthuisberg, Leuven, Belgium
2 Department of Medical Oncology, Hospital Marqués de Valdecilla, Santander, Spain
3 Department of Medical Oncology/Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Canada
4 Haematology, Oncology and Tumour Immunology Clinic, HELIOS-Klinikum Berlin, Robert Rossle Charita Campus, Berlin, Germany
5 Division of Haematology and Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia
6 Medical Oncology Unit 2, Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
7 Department of Biostatistics, Parexel, Paris, France
8 Department of Oncology/Hematology, Centre Hospitalier Notre Dame Reine Fabiola, Charleroi, Belgium
9 Department of Medical Oncology, University General Hospital, Heraklion, Greece
10 Digestive Oncology Unit, University Hospital, Gent, Belgium
11 Department of Oncology, University College London Hospital, London
12 Gastrointestinal and Lymphoma Units, Royal Marsden Hospital, Sutton, UK
* Correspondence to: Prof. Eric Van Cutsem, Digestive Oncology Unit, University Hospital Gasthuisberg, B-3000 Leuven, Belgium. Tel: +32-16-34-42-25; Fax: +32-16-34-44-19; E-mail: eric.vancutsem{at}uz.kuleuven.ac.be
Background: Bevacizumab significantly improves survival when added to chemotherapy for metastatic colorectal cancer (mCRC). The Bevacizumab Expanded Access Trial (BEAT) evaluated the safety and efficacy of bevacizumab plus first-line chemotherapy in a general cohort of patients with mCRC.
Patients and methods: Patients with unresectable mCRC received chemotherapy (physician's choice) plus bevacizumab [5 mg/kg every 2 weeks (5-fluorouracil regimens) or 7.5 mg/kg every 3 weeks (capecitabine regimens)]. The primary end point was safety, including prospective data collection in patients receiving unanticipated surgery during the study. Secondary objectives were progression-free survival (PFS) and overall survival (OS).
Results: The final analysis comprised 1914 assessable patients (male 58%; median age 59 years). Chemotherapy included 5-fluorouracil/leucovorin (5-FU/LV) + oxaliplatin (29%), irinotecan plus 5-FU/LV (26%), capecitabine plus oxaliplatin (18%) and monotherapy (16%). Serious/grade 3–5 adverse events of interest for bevacizumab included bleeding (3%), gastrointestinal perforation (2%), arterial thromboembolism (1%), hypertension (5.3%), proteinuria (1%) and wound-healing complications (1%). Sixty-day mortality was 3%. Median PFS was 10.8 months [95% confidence interval (CI) 10.4–11.3 months] and median OS reached 22.7 months (95% CI 21.7–23.8 months).
Conclusions: The BEAT study shows that the efficacy and safety profile of bevacizumab in routine clinical practice is consistent with results observed in prospective randomised clinical trials and another large observational study in the United States (BRiTE study).
Key words: bevacizumab, chemotherapy, expanded access study, first line, mCRC, metastatic colorectal cancer
Received for publication January 9, 2009. Revision received March 2, 2009. Accepted for publication March 3, 2009.