Lee NY. Lancet Oncol. 2011;doi:10.1016/S1470-2045(11)70303-5.
The use of bevacizumab in addition to radiation
treatment with intensity-modulated radiation therapy was feasible in patients
with nasopharyngeal carcinoma, according to the results of the phase-2 RTOG
Most patients with nasopharyngeal carcinoma who undergo
intensity-modulated radiation therapy (IMRT) have local tumor
control rates of 90% or better; however, nasopharyngeal carcinoma has the
highest metastases rate of any head and neck cancer, with about 30% of patients
developing distant disease.
In this study, the researchers enrolled 46 patients aged
18 years or older with stage IIb-IVb nasopharyngeal carcinoma to determine if
the addition of bevacizumab to treatment was safe. Patients were enrolled at 19
centers in North America and Hong Kong. Only 44 were eligible for analysis.
The treatment regimen for patients consisted of three
Patients were given three cycles of
bevacizumab (15 mg/kg) and cisplatin (100 mg/m2) on days 1,
22 and 43 of IMRT. They then received three more cycles of bevacizumab and
cisplatin (80 mg/m2) on days 64, 85 and 106 after radiation. Finally, three
cycles of fluorouracil (1,000 mg/m2 per day) were given on days 64-67, 85-88,
and 106-109 after radiation.
Patients underwent a median of 2.5 years of follow-up,
during which 9% of patients had locoregional failure and 11% had distant
metastases. Fourteen percent of patients died.
The researchers observed no grade-3/grade-4 hemorrhages
and no grade-5 adverse events. In addition, there were no deaths within 30 days
of treatment completion. Twenty-two percent of patients had grade-1/grade-2
hemorrhage, and 20% had at least one grade-4 blood or bone marrow-related
About 75% of patients had grade-3/grade-4 mucositis, 14%
had grade-3 radiation dermatitis and 5% had grade-3 late xerostomia.
At median follow-up, the estimated 2-year locoregional
progression-free interval was 83.7% and the 2-year distant metastasis-free
interval was 90.8%. Two-year PFS was 74.7% and 2-year OS was 90.9%.
The researchers cautioned the results are preliminary
and concurrent chemoradiation is still the standard treatment for
nasopharyngeal carcinoma. Further research will be needed to identify those
patients who may benefit from additional treatment with bevacizumab, they