A Phase II Study of Capecitabine, Oxaliplatin, and Bevacizumab in the Treatment of Metastatic Esophagogastric Adenocarcinomas

Duke Cancer Institute, Durham, North Carolina, USA
The Oncologist (Impact Factor: 4.87). 03/2013; 18(3). DOI: 10.1634/theoncologist.2012-0404
Source: PubMed


Esophageal and gastric cancers often present at an advanced stage. Systemic chemotherapy is the mainstay of treatment, but survival with current regimens remains poor. We evaluated the safety, tolerability, and efficacy of the combination capecitabine, oxaliplatin, and bevacizumab in the treatment of metastatic esophagogastric adenocarcinomas.

Thirty-seven patients with metastatic or unresectable gastric/gastroesophageal junction tumors were enrolled and treated with capecitabine 850 mg/m(2) BID on days 1-14, and oxaliplatin 130 mg/m(2) with bevacizumab 15 mg/kg on day 1 of a 21-day cycle. The primary endpoint was progression-free survival (PFS). Secondary endpoints included response rate (RR) and overall survival (OS). Neuropilin-1 (NRP1) and -2 (NRP2) mRNA expression was evaluated in archived tumor.

Thirty-five patients were evaluable for efficacy. Median PFS was 7.2 months; median OS was 10.8 months. RR was estimated at 51.4%. The regimen was tolerable with expected drug class-related toxicities. NRP2 mRNA levels significantly correlated with PFS (p = 0.042) and showed a trend toward significance with OS (p = 0.051). Nonsignificant trends for NRP1 were noted for higher expression levels and worse outcome.

Bevacizumab can be given safely with chemotherapy in patients with metastatic esophagogastric adenocarcinomas. The combination of capecitabine, oxaliplatin, plus bevacizumab has activity comparable to other bevacizumab-containing regimens in metastatic gastroesophageal cancer.

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    • "P = 0.0037) and overall response rate (46.0% vs. 37.4%, P = 0.0315) were significantly improved with bevacizumab. Bevacizumab in combination with capecitabine + oxaliplatin showed median PFS of 7.2 mo, median OS of 10.8 mo, and 51.4% response rate in a phase II trial of metastatic gastroesophageal cancer.[22] In another trial, bevacizumab when administered with cisplatin + irinotecan in 47 patients with metastatic/unresectable gastric or gastroesophageal junction tumor, 65% overall response rate (95% CI: 46-80) and median survival of 12.3 mo (95% CI: 11.3-17.2) were observed.[23] "
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