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Traina TA, Rugo HS, Caravelli JF, Patil S, Yeh B, Melisko ME, Park JW, Geneus S, Paulson M, Grothusen J, Seidman AD, Fornier M, Lake D, Dang C, Robson M, Theodoulou M, Flombaum CD, Norton L, Hudis CA, Dickler MN. Feasibility trial of letrozole in combination with bevacizumab in patients with metastatic breast cancer. J Clin Oncol 2010; 28:628-33. [PMID: 19841327 PMCID: PMC3940895 DOI: 10.1200/jco.2009.21.8784] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 06/29/2009] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Preclinical models suggest that the use of anti-vascular endothelial growth factor (anti-VEGF) therapy with antiestrogens may prevent or delay the development of endocrine therapy resistance. We therefore performed a feasibility study to evaluate the safety of letrozole plus bevacizumab in patients with hormone receptor-positive metastatic breast cancer (MBC). METHODS Patients with locally advanced breast cancer or MBC were treated with the aromatase inhibitor (AI) letrozole (2.5 mg orally daily) and the anti-VEGF antibody bevacizumab (15 mg/kg intravenously every 3 weeks). The primary end point was safety, defined by grade 4 toxicity using the National Cancer Institute Common Toxicity Criteria, version 3.0. Secondary end points included response rate, clinical benefit rate, and progression-free survival (PFS). Prior nonsteroidal AIs (NSAIs) were permitted in the absence of progressive disease. RESULTS Forty-three patients were treated. After a median of 13 cycles (range, 1 to 71 cycles), select treatment-related toxicities included hypertension (58%; grades 2 and 3 in 19% and 26%), proteinuria (67%; grades 2 and 3 in 14% and 19%), headache (51%; grades 2 and 3 in 16% and 7%), fatigue (74%; grades 2 and 3 in 19% and 2%), and joint pain (63%; grades 2 and 3 in 19% and 0%). Eighty-four percent of patients had at least stable disease on an NSAI, confounding efficacy results. Partial responses were seen in 9% of patients and stable disease >or= 24 weeks was noted in 67%. Median PFS was 17.1 months. CONCLUSION Combination letrozole and bevacizumab was feasible with expected bevacizumab-related events of hypertension, headache, and proteinuria. Phase III proof-of-efficacy trials of endocrine therapy plus bevacizumab are in progress (Cancer and Leukemia Group B 40503).
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Affiliation(s)
- Tiffany A. Traina
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Hope S. Rugo
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - James F. Caravelli
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Sujata Patil
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Benjamin Yeh
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Michele E. Melisko
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - John W. Park
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Stephanie Geneus
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Matthew Paulson
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Jill Grothusen
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Andrew D. Seidman
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Monica Fornier
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Diana Lake
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Chau Dang
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Mark Robson
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Maria Theodoulou
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Carlos D. Flombaum
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Larry Norton
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Clifford A. Hudis
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Maura N. Dickler
- From the Breast Cancer Medicine Service and the Departments of Radiology, Biostatistics, and Renal Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; and University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
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