Avastin Before Surgery May Help TNBC

The Avastin storyline continues, with research showing once again that the drug (generic name: bevacizumab) can benefit women with triple-negative breast cancer (TNBC). Two studies, both focused on the use of Avastin in neoadjuvant—before surgery—chemotherapy, were published in the Jan. 26 edition of the New England Journal of Medicine.

The most intriguing research, from a TNBC perspective, was conducted in Germany on 1,948 women with an average tumor size of 4 centimeters (about 1.6 inches). All received neoadjuvant chemotherapy of docetaxel, epirubicin and cyclophosphamide. Some were randomly assigned to receive Avastin.

Pathological complete response (pCR) was increased in the 663 women with TNBC who were given the Avastin.

• The pCR of those with TNBC who were not given Avastin was

27.9 percent.

• The pCR of those with TNBC who were given Avastin was 39.3 percent.

Late last year, the Food and Drug Administration recently pulled its approval of the drug because they felt its effectiveness was not significant enough to justify its cause. BUT, the decision did not take into account the fact that Avastin has, in several studies, been shown to be effective for TNBC. The FDA looked at overall results; the fact that Avastin has not been shown to be effective for hormone-positive tumors (the most common kind) skewed the results. Women with TNBC did show a benefit, but because there were so few of them, the benefit appeared statistically insignificant.

That is, not all women benefit from the drug. But women with triple-negative breast cancer might. And previous research has focused on metastatic triple-negative breast cancer (disease that has spread to distant organs). The new studies were on non-metastatic disease.

Some recent articles about it have appeared in Medscape. and Medpage Today.