Malignant pleural mesothelioma (MPM) is a rare, aggressive cancer that affects the lining of the lungs and chest wall. It is often caused by exposure to asbestos and has a poor prognosis with a median survival of around 12 months. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF) and is used in the treatment of several types of cancer, including MPM. In this answer, we will explore the effectiveness of bevacizumab in treating MPM based on current literature.
Mechanism of action
Bevacizumab works by inhibiting VEGF, which is a protein that promotes the growth of blood vessels. By blocking VEGF, bevacizumab can prevent the formation of new blood vessels that tumors need to grow and spread. This mechanism of action makes bevacizumab an attractive treatment option for MPM, which is known to be highly vascularized.
Clinical trials
Several clinical trials have evaluated the efficacy of bevacizumab in combination with chemotherapy for the treatment of MPM. The following is a summary of some of the key trials:
The Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS) trial was a phase III randomized controlled trial that evaluated the addition of bevacizumab to cisplatin and pemetrexed chemotherapy in patients with unresectable MPM. The trial enrolled 448 patients and found that the addition of bevacizumab to chemotherapy improved both progression-free survival (6.9 vs. 5.7 months) and overall survival (18.8 vs. 16.1 months) compared to chemotherapy alone. However, the addition of bevacizumab also increased the incidence of some adverse events, such as bleeding, hypertension, and proteinuria.
The Mesothelioma Antiangiogenic Trial in Combination with Gemcitabine (MATRiX) trial was a phase II trial that evaluated the combination of bevacizumab and gemcitabine chemotherapy in patients with advanced MPM. The trial enrolled 55 patients and found that the combination therapy had a disease control rate of 67%, with a median overall survival of 12.3 months. The most common adverse events were hypertension, proteinuria, and fatigue.
The Italian phase II trial evaluated bevacizumab in combination with cisplatin and gemcitabine chemotherapy in patients with advanced MPM. The trial enrolled 52 patients and found that the combination therapy had a disease control rate of 64%, with a median overall survival of 14.4 months. The most common adverse events were hypertension, fatigue, and proteinuria.
The French phase II trial evaluated bevacizumab in combination with cisplatin and pemetrexed chemotherapy in patients with advanced MPM. The trial enrolled 105 patients and found that the combination therapy had a disease control rate of 55%, with a median overall survival of 13.6 months. The most common adverse events were hypertension, proteinuria, and bleeding.
Overall, these trials suggest that the addition of bevacizumab to chemotherapy may improve outcomes for patients with advanced MPM. However, it is important to note that bevacizumab also increases the risk of some adverse events, which may need to be managed carefully.
Cost-effectiveness
Another important consideration when evaluating the use of bevacizumab in MPM is its cost-effectiveness. Bevacizumab is an expensive drug, and its use may not be feasible or cost-effective in all healthcare settings. A study published in the European Journal of Cancer in 2020 evaluated the cost-effectiveness of bevacizumab in combination with chemotherapy for the treatment of MPM in France. The study found that the addition of bevacizumab to chemotherapy was cost-effective compared to chemotherapy alone, with an incremental cost-effectiveness ratio of €31,600 per quality-adjusted life-year gained.
Conclusion
Bevacizumab is a promising treatment option for patients with advanced MPM. Clinical trials have shown that the addition of bevacizumab to chemotherapy can improve outcomes and prolong survival, although the drug also increases the risk of some adverse events. The cost-effectiveness of bevacizumab in MPM may vary depending on the healthcare setting, and careful consideration of both efficacy and cost is needed when making treatment decisions.
