A Randomized Trial of Bevacizumab, an AntiVascular Endothelial Growth Factor Antibody, for Metastatic Renal Cancer
James C. Yang, M.D., Leah Haworth, B.S.N., Richard M. Sherry, M.D., Patrick Hwu, M.D., Douglas J. Schwartzentruber, M.D., Suzanne L. Topalian, M.D., Seth M. Steinberg, Ph.D., Helen X. Chen, M.D., and Steven A. Rosenberg, M.D., Ph.D.
Background Mutations in the tumor-suppressor gene VHL causeoversecretion of vascular endothelial growth factor by clear-cellrenal carcinomas. We conducted a clinical trial to evaluatebevacizumab, a neutralizing antibody against vascular endothelialgrowth factor, in patients with metastatic renal-cell carcinoma.
Methods A randomized, double-blind, phase 2 trial was conductedcomparing placebo with bevacizumab at doses of 3 and 10 mg perkilogram of body weight, given every two weeks; the time toprogression of disease and the response rate were primary endpoints. Crossover from placebo to antibody treatment was allowed,and survival was a secondary end point.
Results Minimal toxic effects were seen, with hypertension andasymptomatic proteinuria predominating. The trial was stoppedafter the interim analysis met the criteria for early stopping.With 116 patients randomly assigned to treatment groups (40to placebo, 37 to low-dose antibody, and 39 to high-dose antibody),there was a significant prolongation of the time to progressionof disease in the high-doseantibody group as comparedwith the placebo group (hazard ratio, 2.55; P<0.001). Therewas a small difference, of borderline significance, betweenthe time to progression of disease in the low-doseantibodygroup and that in the placebo group (hazard ratio, 1.26; P=0.053).The probability of being progression-free for patients givenhigh-dose antibody, low-doseantibody, and placebo was64 percent, 39 percent, and 20 percent, respectively, at fourmonths and 30 percent, 14 percent, and 5 percent at eight months.At the last analysis, there were no significant differencesin overall survival between groups (P>0.20 for all comparisons).
Conclusions Bevacizumab can significantly prolong the time toprogression of disease in patients with metastatic renal-cellcancer.
Source Information
From the Surgery Branch (J.C.Y., L.H., R.M.S., P.H., D.J.S., S.L.T., S.A.R.), the Biostatistics and Data Management Section (S.M.S.), and the Cancer Therapy Evaluation Program (H.X.C.), National Cancer Institute, Bethesda, Md.
Address reprint requests to Dr. Yang at Rm. 2B-37, Bldg. 10, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, or at james_yang{at}nih.gov.
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Ton, N.C., Parker, G.J.M., Jackson, A., Mullamitha, S., Buonaccorsi, G.A., Roberts, C., Watson, Y., Davies, K., Cheung, S., Hope, L., Power, F., Lawrance, J., Valle, J., Saunders, M., Felix, R., Soranson, J.A., Rolfe, L., Zinkewich-Peotti, K., Jayson, G.C.
(2007). Phase I Evaluation of CDP791, a PEGylated Di-Fab' Conjugate that Binds Vascular Endothelial Growth Factor Receptor 2. Clin. Cancer Res.
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Costa, L. J., Drabkin, H. A.
(2007). Renal Cell Carcinoma: New Developments in Molecular Biology and Potential for Targeted Therapies. The Oncologist
12: 1404-1415
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Cannistra, S. A., Matulonis, U. A., Penson, R. T., Hambleton, J., Dupont, J., Mackey, H., Douglas, J., Burger, R. A., Armstrong, D., Wenham, R., McGuire, W.
(2007). Phase II Study of Bevacizumab in Patients With Platinum-Resistant Ovarian Cancer or Peritoneal Serous Cancer. JCO
25: 5180-5186
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Rudge, J. S., Holash, J., Hylton, D., Russell, M., Jiang, S., Leidich, R., Papadopoulos, N., Pyles, E. A., Torri, A., Wiegand, S. J., Thurston, G., Stahl, N., Yancopoulos, G. D.
(2007). Inaugural Article: VEGF Trap complex formation measures production rates of VEGF, providing a biomarker for predicting efficacious angiogenic blockade. Proc. Natl. Acad. Sci. USA
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Ebbinghaus, S., Hussain, M., Tannir, N., Gordon, M., Desai, A. A., Knight, R. A., Humerickhouse, R. A., Qian, J., Gordon, G. B., Figlin, R.
(2007). Phase 2 Study of ABT-510 in Patients with Previously Untreated Advanced Renal Cell Carcinoma. Clin. Cancer Res.
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Vredenburgh, J. J., Desjardins, A., Herndon, J. E. II, Marcello, J., Reardon, D. A., Quinn, J. A., Rich, J. N., Sathornsumetee, S., Gururangan, S., Sampson, J., Wagner, M., Bailey, L., Bigner, D. D., Friedman, A. H., Friedman, H. S.
(2007). Bevacizumab Plus Irinotecan in Recurrent Glioblastoma Multiforme. JCO
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Harrison, M. L., Obermueller, E., Maisey, N. R., Hoare, S., Edmonds, K., Li, N. F., Chao, D., Hall, K., Lee, C., Timotheadou, E., Charles, K., Ahern, R., King, D. M., Eisen, T., Corringham, R., DeWitte, M., Balkwill, F., Gore, M.
(2007). Tumor Necrosis Factor {alpha} As a New Target for Renal Cell Carcinoma: Two Sequential Phase II Trials of Infliximab at Standard and High Dose. JCO
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Bukowski, R. M., Kabbinavar, F. F., Figlin, R. A., Flaherty, K., Srinivas, S., Vaishampayan, U., Drabkin, H. A., Dutcher, J., Ryba, S., Xia, Q., Scappaticci, F. A., McDermott, D.
(2007). Randomized Phase II Study of Erlotinib Combined With Bevacizumab Compared With Bevacizumab Alone in Metastatic Renal Cell Cancer. JCO
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Dass, C.R., Tran, T.M.N., Choong, P.F.M.
(2007). Angiogenesis Inhibitors and the Need for Anti-angiogenic Therapeutics. JDR
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Guse, K., Ranki, T., Ala-Opas, M., Bono, P., Sarkioja, M., Rajecki, M., Kanerva, A., Hakkarainen, T., Hemminki, A.
(2007). Treatment of metastatic renal cancer with capsid-modified oncolytic adenoviruses. Molecular Cancer Therapeutics
6: 2728-2736
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Morikawa, T., Sugiyama, A., Kume, H., Ota, S., Kashima, T., Tomita, K., Kitamura, T., Kodama, T., Fukayama, M., Aburatani, H.
(2007). Identification of Toll-Like Receptor 3 as a Potential Therapeutic Target in Clear Cell Renal Cell Carcinoma. Clin. Cancer Res.
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Li, Q., Yano, S., Ogino, H., Wang, W., Uehara, H., Nishioka, Y., Sone, S.
(2007). The Therapeutic Efficacy of Anti Vascular Endothelial Growth Factor Antibody, Bevacizumab, and Pemetrexed against Orthotopically Implanted Human Pleural Mesothelioma Cells in Severe Combined Immunodeficient Mice. Clin. Cancer Res.
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Beldner, M., Jacobson, M., Burges, G. E., Dewaay, D., Maize, J. C. Jr., Chaudhary, U. B.
(2007). Localized Palmar Plantar Epidermal Hyperplasia: A Previously Undefined Dermatologic Toxicity to Sorafenib. The Oncologist
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Advani, A., Kelly, D. J., Advani, S. L., Cox, A. J., Thai, K., Zhang, Y., White, K. E., Gow, R. M., Marshall, S. M., Steer, B. M., Marsden, P. A., Rakoczy, P. E., Gilbert, R. E.
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Haines, I. E.
(2007). A Positive Step Forward, but More Needed to Maximize Cost Benefits of New-Generation Cancer Therapies. JCO
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