Bevacizumab implicated in treatment-related death in cancer patients

The angiogenesis inhibitor bevacizumab, used with chemotherapy or biological therapy, carries an increased risk of treatment-related death in cancer patients compared with chemotherapy alone, a new study shows.

Researchers from Stony Brook (New York) University Medical Center conducted a systematic review and meta-analysis of 16 randomized, controlled trials enrolling a total of 10,217 patients with a variety of advanced solid tumors. The trials comprised prospective studies that compared bevacizumab combined with chemotherapy or biological therapy with chemotherapy or biological therapy alone. Overall incidence of fatal adverse events (FAEs) with bevacizumab was 2.5%. Adding bevacizumab to chemotherapy was associated with increased risk of FAEs (relative risk, 1.46) compared with chemotherapy alone.

The risk of FAEs varied significantly (P=.045) with different chemotherapeutic agents but not different types of tumors (P=.13) or different doses of bevacizumab (P=.16). The risk increased in patients receiving taxanes or platinum agents, but not other types of chemotherapy. The most common causes of FAEs in patients receiving bevacizumab were hemorrhage (23.5%), neutropenia (12.2%), and gastrointestinal perforation (7.1%).

“It is important for physicians and patients to recognize the risks as well as the benefits associated with bevacizumab treatment and to monitor closely to identify and treat serious adverse events. . . .Given that the absolute risk of treatment-related mortality appears low, the use of bevacizumab should be considered in the context of overall survival benefits,” the authors write.

The study was published in the February 2 issue of JAMA (2011;305[5]:487-494).