In November, the FDA took the unusual step of nixing Avastin’s approval for advanced breast cancer, saying that the serious risks of using the drug outweighed its small benefits for women with cancer that had spread beyond the breast.
Now new studies are under way looking at whether Avastin may work better if it’s used earlier in the course of the disease as an initial therapy.
Two of those studies are reporting their first round of results this week in the New England Journal of Medicine.
They are not slam dunks for the drug, which prevents the growth of new blood vessels and is meant to starve fast-growing cancer cells by shutting off their blood supply.
Instead, both studies show that Avastin may slightly improve the odds that chemotherapy medications might shrink cancer from the breast before surgeons go in to remove it.
Often, chemotherapy drugs are given to patients after first having surgery to remove a tumor. The drugs are used to kill off any remaining cancer cells after surgery.
But doctors may also give chemotherapy to some patients prior to their operations.
That strategy can sometimes shrink tumors enough so that a woman is able to have only part of her breast removed instead of the whole thing. It can also help doctors refine their treatment plans. If the cancer doesn’t respond well to the first drugs they try against it, they know to try a different plan of attack after surgery.
About 20% of women have their tumors disappear completely after a course of this pre-surgery chemotherapy.
Certainly, says Mary B. Daly, MD, PhD, chair of the department of clinical genetics at the Fox Chase Cancer Center in Philadelphia, disappearance of the cancer before surgery is a hopeful sign.
“Those women tend to do somewhat better, overall, than women for whom there’s still tumor left,” she says.
It is not yet known, however, whether that result -- something doctors call a complete pathological response -- will increase a woman’s chances of survival.