Vascular-endothelial-growth-factor (VEGF) targeting therapies for endocrine refractory or resistant metastatic breast cancer

Bevacizumab with chemotherapy appears to improve progression-free survival, but may not improve overall survival in patients with endocrine refractory or metastatic breast cancer, compared to chemotherapy alone. Risk for adverse events is higher in those treated with bevacizumab.

The quality of evidence is downgraded by study limitations (lack of blinding of outcome assessment).

Summary

A Cochrane review included 8 RCTs to evaluate the benefits in progression-free survival (PFS) and overall survival (OS) and harms (toxicity) of VEGF-targeting therapies in patients with hormone-refractory or hormone-receptor negative metastatic breast cancer. Five trials evaluated chemotherapy with and without bevacizumab in first-line therapy and 3 trials in second-line therapy (Table 1).

The rate of patients who permanently discontinued treatment was significantly higher in the bevacizumab group (OR 1.37; 95% CI 1.13 to 1.66). The overall risk to develop either a serious adverse event (SAE) (OR 1.41; 95% CI 1.13 to 1.75) or an adverse event of grade III or higher (OR 1.77; 95% CI 1.44 to 2.18) was higher in those patients treated with bevacizumab.

Clinical comments

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Ədəbiyyat

1. Wagner AD, Thomssen C, Haerting J et al. Vascular-endothelial-growth-factor (VEGF) targeting therapies for endocrine refractory or resistant metastatic breast cancer. Cochrane Database Syst Rev 2012;7:CD008941.