Information on Avastin and recurrence

Hi Dr. My Mom age 76, is stage 3c OVCA had 8 chemos of Bristaxol and Carboplat, recurred and had 10 chemos of Gemzar and Cisplatin and has now another recurrence to the abdominal lymp nodes and will be treated with Avastin and Genoxal.
Can you tell me if and how Avastin is helpful for OVCA?
Does a recurrence to abdominal lypmh nodes or glands mean the disease is now more aggressive?
Thank you
Elizabeth

[Annekathryn Goodman, M.D.]

Hi There,

avastin is being studied as a treatment for recurrent ovarian cancer and also as a primary treatment. It is usually combined with chemotherapy such as cytoxan or taxol.  There is still very little data on response to avastin. I have pasted a report of a 2005 preliminary study looking at avastin from the gynecologic oncology group.

With 62 patients enrolled, the overall response rate was 17.7% (90% CI, 10.3% to 27.7%) by RECIST criteria. Three patients (4.8%) had a complete response, eight (12.9%) had a partial response, and 34 (54.8%) had stable disease. The median response duration was 10.25 months

More recently, in  Journal of  Clinical  Oncology 2008 Jan 1;volume 26(1)  pages :76-82  a study looked at women with recurrent ovarian cancer:

Treatment consisted of bevacizumab (avastin) 10 mg/kg intravenously every 2 weeks and oral cyclophosphamide 50 mg/d.

RESULTS:
Seventy patients were enrolled.
A partial response was achieved in 17 patients (24%).
Median time to progression was 7.2  months,
Median survival was 16.9 months
The most common serious toxicities were hypertension, fatigue, and pain.
Bevacizumab-related toxicities included four episodes of gastrointestinal perforation or fistula, two episodes each of CNS ischemia (reduced blood flow causing stroke)and pulmonary hypertension, and one episode each of gastrointestinal bleeding and wound healing complication.
There were three treatment-related deaths

I think the bottom line is this new drug has an interesting way of killing cancer cells that is different than chemo. We hope that by suppressing blood vessel growth, we will add another agent to our list of cancer fighting drugs. I am not sure we can really say that just yet.

best wishes

[Jen Y]

What are the factors that contribute to bowel perforations, bleeding, and treatment related deaths while being treated with Avastin?