Studies: Avastin may fight early breast cancers

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Surprising results from two new studies may reopen debate about the value of Avastin for breast cancer. The drug helped make tumors disappear in certain women with early-stage disease, researchers found.

Avastin recently lost approval for treating advanced breast cancer, but the new studies suggest it might help women whose disease has not spread so widely. These were the first big tests of the drug for early breast cancer, and doctors were cautiously excited that it showed potential to help.

In one study, just over one third of women given Avastin plus chemotherapy for a few months before surgery had no sign of cancer in their breasts when doctors went to operate, versus 28 percent of women given chemo alone. In the other study, more than 18 percent on Avastin plus chemo had no cancer in their breasts or lymph nodes at surgery versus 15 percent of those on chemo alone.

A big caveat, though: The true test is whether Avastin improves survival, and it's too soon to know that — both studies are still tracking the women's health. The drug also has serious side effects.

"I don't think it's clear yet whether this is going to be a winner," Dr. Harry Bear of Virginia Commonwealth University said of Avastin. But he added, "I don't think we're done with it."

Bear led one study, in the United States. Dr. Gunter von Minckwitz of the University of Frankfurt led the other in Germany. Results are in Thursday's New England Journal of Medicine.

Avastin (uh-VAS'-tihn) is still on the market for some colon, lung, kidney and brain tumors. In 2008, it won conditional U.S. approval for advanced breast cancer because it seemed to slow the disease. Further research showed it didn't meaningfully extend life and could cause heart problems, bleeding and other problems. The government revoked its approval for breast cancer in November.

Now doctors can prescribe Avastin for breast cancer but insurers may not pay. Treatment can cost $10,000 a month. The drug is made by California-based Genentech, part of the Swiss company Roche. It is still approved for treating advanced breast cancer in Europe and Japan.

The new studies tested it in a relatively novel way — before surgery. This is sometimes done to shrink tumors that seem inoperable, or to enable women to have just a lump removed instead of the whole breast.

The women in the studies had tumors that were large enough to warrant treatment besides surgery. Their cancers were not the type that can be treated by Herceptin, another widely used drug.

In the U.S. study, 1,200 women were given chemo or chemo plus infusions of Avastin. By the time of their surgery, no cancer could be found in the breasts of more than 34 percent of those given Avastin versus 28 percent of the others. (Surgeons still have to operate because they don't know the tumor is gone until they check tissue samples.)

The German study involved 1,900 women including some with larger tumors. It used a stricter definition of cancer-free at surgery: no sign of disease in the breast or lymph nodes rather than just the breast. No cancer was seen in 18 percent of women on Avastin versus 15 percent of those given only chemo. Different chemo drugs were used — a factor that might change Avastin's effectiveness.

The U.S. study was paid for by the National Cancer Institute with some support from drug companies. The German study was sponsored by drug companies. Some researchers consult for Genentech or other makers of cancer drugs.

If even one of these studies shows a survival advantage for Avastin "that would be a game changer" although side effects remain a concern, said Dr. Gary Lyman. He is a Duke University researcher who was on the federal advisory panel that recommended revoking Avastin's approval.

However, von Minckwitz said side effects are more justifiable in early breast cancer patients because "the intention is cure" rather than in late-stage disease where cure isn't usually possible.

Of the more than 200,000 women in the U.S. diagnosed each year with breast cancer, about 30,000 are like those in the new studies, Lyman estimated.

But the studies' impact could be far greater: The participants' tissue samples are being analyzed for genes and biomarkers to predict which women are most likely to respond to Avastin. That could lead to a relook of using the drug for certain women with advanced disease, too.

Three other studies are under way testing Avastin in early breast cancer; one is expected to have results by the end of this year, said Dr. Sandra Horning, global development chief of cancer drugs for Roche and Genentech. The company does not plan to seek any change in Avastin's use until more results are available, she said.

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Online:

Studies: http://www.nejm.org

Avastin: http://www.avastin.com

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Associated Press

Source AP

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Women's cancers reach two million

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14 September 2011 Last updated at 21:43 GMT By Helen Briggs Health editor, BBC News website There have been steady increases in breast cancer deaths in the developed and developing world Two million women were diagnosed with breast or cervical cancer last year, according to global figures.

A sharp rise in cases was seen in women under 50 in low-income nations, say US experts.

Women in richer countries fared better due in part to screening, medicines, anti-smoking policies and vaccines, they report in the Lancet.

The research backs calls for world leaders to make cancer prevention a priority in the developing world.

The new global statistics from hundreds of cancer registries worldwide found there were about 2 million new cases of breast and cervical cancer in 2010, and 625,000 deaths.

The analysis, by the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, highlighted a sharp rise in breast and cervical cancer among younger women in developing countries.

Cancer charities and scientists are calling for these diseases to be given a similar global priority to maternal mortality.

Continue reading the main story

Worldwide figures on breast cancer show cases are rising every year at a rate of about 3%, while death rates are also rising - at about 2% a year.

According to experts, this is driven partly by the ageing population and partly by a host of other factors, including diet, obesity, genetics, economics and the availability of national screening programmes.

Research evidence shows that some of these deaths are preventable, through early screening and treatment for breast cancer, HPV vaccination for cervical cancer, cervical cancer screening and anti-smoking measures.

The question for policy-makers is how to make such programmes available to more women around the world.

Vaccines against the virus linked to cervical cancer, for example, will only be used more widely when the cost falls.

Broad actions are warranted, supported by global funds, say public health experts.

In the past, complications during childbirth and pregnancy were among the leading causes of death in women of reproductive age in the developing world.

However, current trends suggest breast and cervical cancer deaths are starting to overtake, in poorer countries.

Study co-author, Dr Alan Lopez, of the University of Queensland, Australia, said: "We have poured an enormous amount of resources into addressing the serious concern of maternal mortality worldwide, and we've seen a great deal of progress.

"To expand that commitment, breast and cervical cancer need to become a standard part of the efforts aimed at saving more mothers' lives."

Mixed picture

The research in 187 countries for the period 1980-2010 highlighted stark differences in a woman's chances of developing, and surviving, cancer.

In the UK, a woman's risk of dying from breast cancer has fallen from 1 in 32 in 1980, to 1 in 47 by 2010. In countries such as Rwanda, however, the trend has reversed, with 1 in 60 women now at risk, compared with 1 in 97 in 1980.

Dr Rafael Lozano, professor of global health at IHME, another co-author of the paper, said the world used to think of breast cancer as a problem for high-income countries but as the world has become more globalised, this is starting to change.

"The main known risk factors for breast cancer - poor diet and obesity - are now becoming more commonplace in poor countries," he said.

"We have found that while countries such as the United States and United Kingdom have been able to lower the risks of women dying from breast cancer, through better screening and treatment, countries with fewer resources are seeing the risks go up."

With cervical cancer, the number of cases and deaths are rising more slowly than breast cancer, he added, with the number of deaths from cervical cancer going down in high-income countries.

"Our concern is that this is a disease that is almost entirely preventable through safe sex practices and early detection, yet it continues to kill nearly a half a million women every year.

"With the right investments and targeted policies, like the ones we have seen in places such as the UK, we can reverse this trend."

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