Short-Course Bicalutamide with or without Bevacizumab

[pjoshea13]

New study below.

6-month treatment after primary treatment failure.

Seems odd to me - I wonder what they had in mind other than demonstrating an add-on benefit for bevacizumab?

This statement makes no sense to me: 

"Patients were randomly assigned 2:1 to a luteinizing hormone-releasing hormone agonist (bicalutamide or bevacizumab) or ADT alone ...

- bicalutamide (Casodex) is an antiandrogen - not a luteinizing hormone-releasing hormone agonist, but often combined with one. 

- bevacizumab (Avastin) is a very expensive angiogenesis inhibitor with a disappointing track record.

Elsewhere, the statement has been rephrased:

"Participants were randomly assigned 2:1 to receive bicalutamide as ADT plus bevacizumab or ADT alone ..." [2]  Seems to confirm Casodex as ADT monotherapy!

"Relapse was defined as a PSA of more than 0.2 ng/mL for prostatectomy patients or PSA of more than 2.0 ng/mL for primary radiation therapy patients."

Time to relapse: 10.2 months for Casodex; 13.3 months for Casodex+Avastin.

"... key eligibility criteria included increasing PSA level (≤50 ng/mL), PSA doubling time <18 months, low-burden metastatic or nonmetastatic disease, and asymptomatic metastases (lymph nodes <3 cm, ≤5 bony metastases) ..." [3]

The same team had a paper last April:

"Docetaxel, bevacizumab, and androgen deprivation therapy for biochemical relapse after definitive local therapy for prostate cancer"  [4]

"Forty-one patients are included in the analysis. At one year following completion of ADT, 45% (n=13/29) and 29% (n=5/17) of patients with a testosterone ≥100 ng/dL and testosterone ≥ 240 ng/dL had a PSA < 0.2 ng/mL. The median follow-up is 27.5 months (inter-quartile range: 21.8, 38.1). Eight (20%) patients are free from PSA progression, 19 (46%) did not restart ADT, and 34 (83%) are free from metastasis. Sixteen (39%) patients experienced grade 3 and five (12%) experienced grade 4 toxicities."

-Patrick

[1]  ncbi.nlm.nih.gov/pubmed/270...

[2]  cancertherapyadvisor.com/pr...

[3]  medpagetoday.com/clinical-c...

[4]  ncbi.nlm.nih.gov/pmc/articl...

[maack1]

I am as surprised as you, Patrick, that NCBI would release for print remarking that "bicalutamide/bevacizumab" are luteinizing hormone-releasing hormone agonists..  In any event, from what they have concluded, bicalutamide alone was not that far off from the combination with bevacizumab that the combination would have signifcant merit.  As you remark, bevacizumab/Avastin is much more costly, requires infusion, and with the result close enough to not be overly significant, questions its merit.  Bevacizumab also has side effects that can be deadly for some, particularly if not monitored very closely.