Mesothelioma patients who had induction chemotherapy with Avastin (bevacizumab) prior to surgery responded better than those who had only chemotherapy in a new Swedish study.
Researchers at the University Hospital Zurich analyzed the cases of 88 pleural mesothelioma patients who were slated to have surgery.
Most of the patients had standard chemotherapy before surgery. Some had induction chemotherapy with Avastin. Those who got the extra drug had a “significantly better response” according to a new report in Frontiers in Oncology.
The Use of Induction Chemotherapy with Avastin or Without
Induction chemotherapy is chemotherapy delivered before mesothelioma surgery. The goal of the treatment is to shrink the mesothelioma tumor as much as possible. This may improve the odds that surgeons can remove it completely. The more complete the surgery is, the less likely patients are to experience mesothelioma recurrence.
The most common chemotherapy drugs for mesothelioma are Alimta (pemetrexed) and cisplatin or carboplatin. In the new study, 66 patients had this combination before surgery. The other 22 patients had induction chemotherapy with Avastin.
Avastin is the brand name for bevacizumab. It is an anti-VEGF drug. That means that it blocks a protein that promotes the growth of new blood vessels.
Mesothelioma tumors need a fresh blood supply to grow. Induction chemotherapy with Avastin may slow their growth. This may make them easier to remove.
Chemotherapy + Surgery for Mesothelioma
The study focused on Swedish mesothelioma patients treated between 2002 and 2018. The researchers matched patients according to gender, subtype, and other risk factors. They narrowed the group down to 88 people.
Twenty-five percent of the patients had induction chemotherapy with Avastin. The rest had standard chemotherapy. They all had surgery to remove as much cancer as possible.
“Patients undergoing combination treatment with bevacizumab had a significantly better response than with chemotherapy alone,” writes lead author Olivia Lauk.
Another study showed colon cancer patients who got Avastin before surgery had bleeding problems. But this was not a problem for the mesothelioma patients. In fact, patients who had induction chemotherapy with Avastin needed fewer blood transfusions than the other group.
“These initial data demonstrate that MCR can be performed safely after triple induction chemotherapy with [Avastin] bevacizumab without increased intra- and postoperative bleeding complications,” the report concludes.
Other Research on Bevacizumab
Japanese researchers released the first study on chemotherapy with Avastin for pleural mesothelioma. That study came out in September. It focused on seven patients who were not eligible for surgery. Mesothelioma tumors stopped growing in four patients who got the bevacizumab. They shrunk in two patients.
In France, the combination is already standard-of-care for mesothelioma. The US National Comprehensive Cancer Network guidelines list chemotherapy with Avastin as an option for first-line mesothelioma treatment.
Lauk, O, et al, “The Impact on Outcome by Adding Bevacizumab to Standard Induction Chemotherapy Prior to Mesothelioma Surgery: A Retrospective Single Center Analysis”, November 13, 2020, Frontiers in Oncology, eCollection, https://www.frontiersin.org/articles/10.3389/fonc.2020.588563/full
Nakano, T, et al, “Bevacizumab plus cisplatin/pemetrexed then bevacizumab alone for unresectable malignant pleural mesothelioma: A Japanese safety study, September 7, 2020, Asia Pacific Journal of Clinical Oncology, Epub ahead of print, https://pubmed.ncbi.nlm.nih.gov/32893992/