Journal Article

Transarterial chemoembolization plus or minus intravenous bevacizumab in the treatment of hepatocellular cancer: A pilot study

Xin, Yan, Gomes, Antoinette S, Wainberg, Zev A, Busuttil, Ronald W, Finn, Richard S, Slamon, Dennis J, Elashoff, David, Britten, Carolyn D, Amado, Rafael

2012

Overview

Background Stimulation of vascular endothelial growth factor (VEGF) has been observed following transarterial chemoembolization (TACE) in hepatocellular cancer (HCC) and may contribute to tumor regrowth. This pilot study examined whether intravenous (IV) bevacizumab, a monoclonal antibody against VEGF, could inhibit neovessel formation after TACE. Methods 30 subjects with HCC undergoing TACE at a single academic institution were randomized with a computer-generated allocation in a one to one ratio to either bevacizumab at a dose of 10 mg/kg IV every 14 days beginning 1 week prior to TACE (TACE-BEV arm) or observation (TACE-O arm). Angiography was performed with TACE at day 8, and again at weeks 10 and 14. Repeat TACE was performed at week 14 if indicated. TACE-BEV subjects were allowed to continue bevacizumab beyond week 16. TACE-O subjects were allowed to cross-over to bevacizumab at week 16 in the setting of progressive disease. The main outcome measure was a comparison of neovessel formation by serial angiography. Secondary outcome measures were progression free survival (PFS) at 16 weeks, overall survival (OS), bevacizumab safety, and an analysis of VEGF levels before and after TACE with and without bevacizumab. Results Among the 30 subjects enrolled, 9 of 15 randomized to the TACE-O arm and 14 of 15 randomized to the TACE-BEV arm completed all 3 angiograms. At week 14, 3 of 9 (33%) TACE-O subjects and 2 of 14 (14%) TACE-BEV subjects demonstrated neovascularity. The PFS at 16 weeks was 0.19 in the TACE-O arm and 0.79 in the TACE-BEV arm ( p = 0.021). The median OS was 61 months in the TACE-O arm and 49 months in the TACE-BEV arm ( p = 0.21). No life-threatening bevacizumab-related toxicities were observed. There were no substantial differences in bevacizumab pharmacokinetics compared to historical controls. Bevacizumab attenuated the increase in VEGF observed post-TACE. Conclusions IV bevacizumab was well tolerated in selected HCC subjects undergoing TACE, and appeared to diminish neovessel formation at week 14. Trial registration ClinicalTrials.gov NCT00049322 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Angiogenesis / Angiogenesis Inhibitors - administration & dosage / Angiogenesis Inhibitors - pharmacokinetics / Antibodies, Monoclonal, Humanized - administration & dosage / Antibodies, Monoclonal, Humanized - pharmacokinetics / Bevacizumab / Biomedical and Life Sciences / Biomedicine / Cancer / Cancer Research / Carcinoma, Hepatocellular - blood supply / Carcinoma, Hepatocellular - metabolism / Carcinoma, Hepatocellular - therapy / Care and treatment / Chemoembolization, Therapeutic - methods / Clinical trials / Design / Experimental therapeutics and drug development / Female / Health aspects / Health Promotion and Disease Prevention / Hepatoma / Humans / Injections, Intravenous / Liver cancer / Liver diseases / Liver Neoplasms - blood supply / Liver Neoplasms - metabolism / Liver Neoplasms - therapy / Male / Medicine / Medicine/Public Health / Middle Aged / Mortality / Neovascularization, Pathologic - prevention & control / Oncology / Patient outcomes / Pilot Projects / Research Article / Surgical Oncology / Survival Analysis / Therapeutic chemoembolization / Vascular endothelial growth factor / Vascular Endothelial Growth Factor A - metabolism