Please use this identifier to cite or link to this item: https://doi.org/10.1200/JCO.2011.39.9824
Title: Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: A biomarker evaluation from the AVAGAST randomized phase III trial
Authors: Van Cutsem, E.
De Haas, S.
Kang, Y.-K.
Ohtsu, A.
Tebbutt, N.C.
Xu, J.M.
Yong, W.P. 
Langer, B.
Delmar, P.
Scherer, S.J.
Shah, M.A.
Issue Date: 10-Jun-2012
Citation: Van Cutsem, E., De Haas, S., Kang, Y.-K., Ohtsu, A., Tebbutt, N.C., Xu, J.M., Yong, W.P., Langer, B., Delmar, P., Scherer, S.J., Shah, M.A. (2012-06-10). Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: A biomarker evaluation from the AVAGAST randomized phase III trial. Journal of Clinical Oncology 30 (17) : 2119-2127. ScholarBank@NUS Repository. https://doi.org/10.1200/JCO.2011.39.9824
Abstract: Purpose: The AVAGAST study showed that adding bevacizumab to chemotherapy in patients with advanced gastric cancer improves progression-free survival and tumor response rate but not overall survival. To examine the hypothesis that angiogenic markers may have predictive value for bevacizumab efficacy in gastric cancer, AVAGAST included a prospective, mandatory biomarker program. Patients and Methods: Patients with previously untreated, locally advanced or metastatic gastric cancer were randomly assigned to bevacizumab (n = 387) or placebo (n = 387) in combination with chemotherapy. Blood and tumor tissue samples were collected at baseline. Prespecified biomarkers included plasma vascular endothelial growth factor-A (VEGF-A), protein expression of neuropilin-1, and VEGF receptors-1 and -2 (VEGFR-1 and VEGFR-2). Correlations between biomarkers and clinical outcomes were assessed by using a Cox proportional hazards model. Results: Plasma was available from 712 patients (92%), and tumor samples were available from 727 patients (94%). Baseline plasma VEGF-A levels and tumor neuropilin-1 expression were identified as potential predictors of bevacizumab efficacy. Patients with high baseline plasma VEGF-A levels showed a trend toward improved overall survival (hazard ratio [HR], 0.72; 95% CI, 0.57 to 0.93) versus patients with low VEGF-A levels (HR, 1.01; 95% CI, 0.77 to 1.31; interaction P = .07). Patients with low baseline expression of neuropilin-1 also showed a trend toward improved overall survival (HR, 0.75; 95% CI, 0.59 to 0.97) versus patients with high neuropilin-1 expression (HR, 1.07; 95% CI, 0.81 to 1.40; interaction P = .06). For both biomarkers, subgroup analyses demonstrated significance only in patients from non-Asian regions. Conclusion: Plasma VEGF-A and tumor neuropilin-1 are strong biomarker candidates for predicting clinical outcome in patients with advanced gastric cancer treated with bevacizumab. © 2012 by American Society of Clinical Oncology.
Source Title: Journal of Clinical Oncology
URI: http://scholarbank.nus.edu.sg/handle/10635/116937
ISSN: 0732183X
DOI: 10.1200/JCO.2011.39.9824
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