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Addition of Bevacizumab to First-Line Palliative Chemotherapy in Patients with Metastatic Small Bowel Adenocarcinoma: A Population-Based Study

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Abstract

Background

Data about the use and effectiveness of targeted therapy in metastatic small bowel adenocarcinoma (SBA) are scarce.

Objective

The aim of this population-based study was to obtain insights into the use and effectiveness of targeted therapy in patients with synchronous metastases of SBA.

Patients and methods

Data were retrieved from the Netherlands Cancer Registry. Patients treated with palliative chemotherapy and/or targeted therapy for synchronous metastatic SBA between 2007 and 2016 were included (n = 187). Differences in treatment and the subsequent effects on overall survival (OS) were evaluated.

Results

In first-line treatment, 25 patients (13%) received additional targeted therapy, exclusively bevacizumab, and mostly in combination with CAPOX/FOLFOX (n = 24). A primary ileal tumour was predictive for receiving bevacizumab in first-line treatment (odds ratio 3.2, 95% confidence interval (CI) 1.06–9.93). Median OS for patients in whom bevacizumab was added to first-line chemotherapy was 9.3 months, compared to 9.1 months with chemotherapy only (p = 0.85). Median OS for patients receiving first-line treatment only was 8.5 months with and 6.4 months without the addition of bevacizumab, respectively (p = 0.54). In multivariable survival analyses, the addition of bevacizumab was no prognostic factor (hazard ratio 1.01, 95% CI 0.65–1.59).

Conclusions

Bevacizumab was the only prescribed targeted therapy in first-line treatment. Considering the limited number of patients receiving first-line bevacizumab and the unknown reasons to prescribe additional targeted therapy, the corresponding survival rates of patients treated with and without additional bevacizumab in first-line treatment might suggest a limited clinical effect of bevacizumab in addition to first-line palliative chemotherapy on OS. Future research should focus on identifying the subgroup of patients who might benefit from anti-VEGF therapy in metastatic SBA.

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Acknowledgements

The authors thank the registration team of the Netherlands Cancer Registry for their dedicated data collection. We thank Nienke Bosman, Claudia van Leeuwen and Erica Masseling for their contribution to additional data collection.

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Authors and Affiliations

  1. Department of Medical Oncology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Laura M. Legué, Nienke Bernards & Geert-Jan Creemers

  2. Department of Research, Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands

    Laura M. Legué, Felice N. van Erning, Valery E. P. P. Lemmens & Ignace H. J. T. de Hingh

  3. Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands

    Valery E. P. P. Lemmens

  4. Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands

    Ignace H. J. T. de Hingh

  5. School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands

    Ignace H. J. T. de Hingh

Authors
  1. Laura M. Legué
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  2. Felice N. van Erning
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  3. Nienke Bernards
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  4. Valery E. P. P. Lemmens
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  6. Geert-Jan Creemers
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Corresponding author

Correspondence to Laura M. Legué.

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Funding

This work was financially supported by a grant from the Catharina Research Fund, which was used for additional data collection, and had no involvement in relation to the presented outcomes.

Conflict of interest

LL, FvE, NB, VL, IdH and GC declare that they have no conflicts of interest that might be relevant to the contents of this article.

Ethical approval

According to the Central Committee on Research involving Human Subjects (CCMO), this type of study does not require approval from an ethics committee.

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Legué, L.M., van Erning, F.N., Bernards, N. et al. Addition of Bevacizumab to First-Line Palliative Chemotherapy in Patients with Metastatic Small Bowel Adenocarcinoma: A Population-Based Study. Targ Oncol 14, 699–705 (2019). https://doi.org/10.1007/s11523-019-00681-1

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  • DOI: https://doi.org/10.1007/s11523-019-00681-1

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