How to manage bevacizumab for metastatic breast cancer?

Abstract

Bevacizumab (Bmab) is humanized monoclonal antibody for vascular endothelial growth factor (VEGF) and inhibits angiogenic activity of VEGF. Several randomized trials have been conducted to elucidate the role of Bmab in treatment for breast cancer (BC). Although Bmab‐containing chemotherapy (CT) was useful for only HER2‐negative metastatic BC (MBC), Bmab‐containing CT did not show the superiority compared with CT in adjuvant setting and HER2‐positive MBC. Bmab had higher response rate and longer PFS but not prolonged OS than standard CT in HER2‐negative MBC. In addition, Bmab had specific adverse events such as hypertension, proteinuria, GI perforation and thromboembolism. Bmab‐containing CT use is not strongly recommended in 1st line MBC in Japan from these reasons. However, some patients need to receive benefit from Bmab‐containing CT that involves avoiding early death and high objective response. Predictive marker for Bmab use has not been confirmed yet although plasma VEGF‐A and soluble VEGF‐R2 are candidate of predictive markers for Bmab. Recently, some investigators tried to find effective Bmab use through the in vivo screening. For patients without progression after 4 to 6 cycles of Bmab‐containing CT, new regimen or approach are investigated. This approach concentrates patients with more effective and less toxic for Bmab and can lead to more specific effect of Bmab for patients who need Bmab. I will review how to use Bmab for patients with MBC from evidence. In addition, I will discuss this approach to solve one of problem of Bmab use in MBC.