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Authors: Dr. Sunil Verma Date posted: June 22 nd , 2009

Ribbon-1: Randomized, double-blind, placebo, phase III trial of first line chemo with or without bevacizumab for MBC Presented by: N. Robert. Authors: Dr. Sunil Verma Date posted: June 22 nd , 2009. Treatment A: Chemo up to the Investigator

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Authors: Dr. Sunil Verma Date posted: June 22 nd , 2009

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  1. Ribbon-1: Randomized, double-blind, placebo, phase III trial of first line chemo with or without bevacizumab for MBCPresented by: N. Robert Authors: Dr. Sunil Verma Date posted: June 22nd, 2009

  2. Treatment A: Chemo up to the Investigator ( one of anthracyclines, taxanes or capecitabine) and Placebo R Treatment B: Chemo (as per above) and Bevacizumab 15mg/kg q 3 wk Metastatic Breast Cancer (First Line)

  3. RESULTS Taxane and Anthracyclines

  4. RESULTS Capecitabine

  5. STUDY COMMENTARY • Two (E2100 and AVADO) previous MBC trials have shown that the addition of bevacizumab to first line taxane based chemo led to improvement in PFS, but not OS • This is a placebo controlled trial that shows that addition of Bevacizumab to chemotherapy (either Capecitabine or Anthracline/Taxane) improves PFS • The benefit appeared more pronounced in combination with Capecitabine • About 50-70% of patients received Bevacizumab in the second line setting including those who were in the placebo-arm • There was no statistically significant improvement in OS

  6. BOTTOM LINE FOR CANADIAN MEDICAL ONCOLOGISTS • Health Canada recently approved Bevacizumab in first line treatment of MBC (Feb. 2009) • We need to have better treatment for those who have progressed on Anthracyclines and taxanes in the adjuvant setting. • Capecitabine is increasingly being considered in the first line setting • We still need to define the patient population which derives the most benefit from this drug • The adjuvant study of this class of drugs needs to be done in a defined population with extensive biomarker evaluation

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