Brain Tumor Action Network

Typical survival now just 3 months
Jean P. Fisher, Staff Writer

The cancer drug Avastin — an established but expensive treatment for lung, breast and colon cancers — may also be a powerful weapon against the most deadly type of brain tumor. Patients with recurrent glioblastoma multiforme often live just three months after their tumor is detected.

With standard chemotherapy drugs, tumors come back within six months in about 75 percent of patients. Fewer than half live past six months. But physicians at Duke University Medical Center found that Avastin and a common chemotherapy drug roughly doubled expected survival to at least six months in 80 percent of patients. Half the patients saw a halt to new tumor growth.

The findings are published in the Oct. 20 issue of the Journal of Clinical Oncology.

“There is no standard treatment that improves survival, so this is extremely promising,” said Dr. James Vredenburgh, a Duke neuro-oncologist and principal investigator on the Avastin study. The trial tested the two-drug combination in 35 patients with recurrent glioblastoma.

The Duke team was among the first to study Avastin, which is made by the biotechnology company Genentech, as a possible therapy for glioblastoma. They are the first research group to demonstrate the drug can significantly increase survival among patients with the deadly brain tumor.

Avastin has emerged in recent years as one of the most powerful new tools oncologists use to fight cancers. The drug works by interfering with the tangled web of vessels that forms around a tumor, cutting off its supply of nutrients and oxygen. Duke paired Avastin with a second chemotherapy drug called irinotecan, which attacks the cancer cells themselves.

Dr. Matthew Ewend, chief of neurosurgery at UNC Hospitals in Chapel Hill, said the increased survival Duke scientists observed is exciting. But he said more research, especially a large study comparing patients treated with Avastin to those who receive standard treatment alone, is needed to show that Avastin is truly the best treatment for glioblastoma, which strikes about 10,000 new patients a year.

“We don’t have anything very good to offer these patients right now, and there is a lot of enthusiasm for Avastin” to fill the gap, Ewend said. But, he said, other therapies haven’t held up when put to the test in larger trials.

Ewend said Avastin’s astronomical price puts an even greater burden on the medicine to show that it is the best treatment for glioblastoma. It costs about $100,000 a year to treat a patient with lung or breast cancer with the drug. But it would be even more expensive for glioblastoma, which takes higher doses. Each treatment given to patients in the Duke study cost between $15,000 and $25,000, so a year’s course of 27 biweekly infusions can cost up to $675,000.

Currently, health insurers often won’t cover Avastin for glioblastoma because the drug is not yet approved for that use. Vredenburgh, the Duke oncologist, agrees that more research is needed before both FDA and health insurers will be persuaded it should be standard therapy for patients with glioblastoma.

“We often want to give it to these patients, and we can’t get it paid for,” Ewend said.

Woodrow “Jerry” Jarrell Jr., who lives 20 miles north of Asheville in the town of Mars Hill, doubts he would be alive today without Avastin. He was diagnosed with glioblastoma in November 2004 and had immediate surgery to remove a tumor the size of a pingpong ball, followed by chemotherapy and radiation.

Jarrell’s doctors in Asheville transferred him to Duke in February 2005, and within a month tests showed the cancer was back. After another surgery and an unsuccessful stint on a clinical trial at Duke, Jarrell enrolled in the Avastin study.

The first three treatments cut the size of the tumor in half. Six months into the yearlong regimen, doctors at Duke told him it appeared to be gone. He is now nearly three years out from his initial diagnosis.

“I am a blessed, blessed human being,” said Jarrell, 66.

or (919) 829-4753

Click here to view original story.