Analysis of early hypertension and clinical outcome with bevacizumab: Results from seven phase III studies

Herbert I. Hurwitz, Pamela S. Douglas, John P. Middleton, George W. Sledge, David H. Johnson, David A. Reardon, Dafeng Chen, Oliver Rosen

Research output: Contribution to journalArticle

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Abstract

Background. Hypertension is associated with antivascular endothelial growth factor treatment, but the clinical implications of hypertension are uncertain. To assess the prognostic and predictive value of bevacizumab-related hypertension, a comprehensive analysis of whether hypertension and efficacy outcomes are associated was conducted on seven companysponsored placebo-controlled phase III studies of bevacizumab. Methods. Patient-specific data were available from 6,486 patients with metastatic colorectal, breast, non-small cell lung, pancreatic, and renal cell cancers. Primary hypertension endpoint was a blood pressure (BP) increase of >20 mmHg systolic or >10 mmHg diastolic within the first 60 days of treatment. Additional endpoints included other predefined thresholds of change in BP and severity of hypertension graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events. To analyze the general prognostic importance of an early BP increase, multivariate Cox regression models were used to assess the correlation between BP changes and progression-free (PFS) and overall survival (OS) outcomes in the control groups. To analyze whether early BP increases could predict for benefit from bevacizumab, similar analyses were conducted in the bevacizumabtreated and control groups. Results. In six of seven studies, early BP increase was neither predictive of clinical benefit from bevacizumab nor prognostic for the course of the disease. For study AVF2107g, early increased BP was associated with longer PFS and OS times in the bevacizumab group but shorter OS time in the control group. Conclusions. Early treatment-related BP increases do not predict clinical benefit from bevacizumab based on PFS or OS outcomes. BP increases do not appear to have general prognostic importance for patients with advanced cancer.

Original languageEnglish (US)
Pages (from-to)273-280
Number of pages8
JournalOncologist
Volume18
Issue number3
DOIs
StatePublished - Mar 2013

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Blood Pressure
Hypertension
Survival
Control Groups
Endothelial Growth Factors
Bevacizumab
National Cancer Institute (U.S.)
Renal Cell Carcinoma
Proportional Hazards Models
Terminology
Breast
Therapeutics
Placebos
Lung
Neoplasms

Keywords

  • Bevacizumab
  • Clinical outcome
  • Hypertension
  • Predictive factor
  • Prognostic factor

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Hurwitz, H. I., Douglas, P. S., Middleton, J. P., Sledge, G. W., Johnson, D. H., Reardon, D. A., ... Rosen, O. (2013). Analysis of early hypertension and clinical outcome with bevacizumab: Results from seven phase III studies. Oncologist, 18(3), 273-280. https://doi.org/10.1634/theoncologist.2012-0339

Analysis of early hypertension and clinical outcome with bevacizumab : Results from seven phase III studies. / Hurwitz, Herbert I.; Douglas, Pamela S.; Middleton, John P.; Sledge, George W.; Johnson, David H.; Reardon, David A.; Chen, Dafeng; Rosen, Oliver.

In: Oncologist, Vol. 18, No. 3, 03.2013, p. 273-280.

Research output: Contribution to journalArticle

Hurwitz, HI, Douglas, PS, Middleton, JP, Sledge, GW, Johnson, DH, Reardon, DA, Chen, D & Rosen, O 2013, 'Analysis of early hypertension and clinical outcome with bevacizumab: Results from seven phase III studies', Oncologist, vol. 18, no. 3, pp. 273-280. https://doi.org/10.1634/theoncologist.2012-0339
Hurwitz, Herbert I. ; Douglas, Pamela S. ; Middleton, John P. ; Sledge, George W. ; Johnson, David H. ; Reardon, David A. ; Chen, Dafeng ; Rosen, Oliver. / Analysis of early hypertension and clinical outcome with bevacizumab : Results from seven phase III studies. In: Oncologist. 2013 ; Vol. 18, No. 3. pp. 273-280.
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AB - Background. Hypertension is associated with antivascular endothelial growth factor treatment, but the clinical implications of hypertension are uncertain. To assess the prognostic and predictive value of bevacizumab-related hypertension, a comprehensive analysis of whether hypertension and efficacy outcomes are associated was conducted on seven companysponsored placebo-controlled phase III studies of bevacizumab. Methods. Patient-specific data were available from 6,486 patients with metastatic colorectal, breast, non-small cell lung, pancreatic, and renal cell cancers. Primary hypertension endpoint was a blood pressure (BP) increase of >20 mmHg systolic or >10 mmHg diastolic within the first 60 days of treatment. Additional endpoints included other predefined thresholds of change in BP and severity of hypertension graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events. To analyze the general prognostic importance of an early BP increase, multivariate Cox regression models were used to assess the correlation between BP changes and progression-free (PFS) and overall survival (OS) outcomes in the control groups. To analyze whether early BP increases could predict for benefit from bevacizumab, similar analyses were conducted in the bevacizumabtreated and control groups. Results. In six of seven studies, early BP increase was neither predictive of clinical benefit from bevacizumab nor prognostic for the course of the disease. For study AVF2107g, early increased BP was associated with longer PFS and OS times in the bevacizumab group but shorter OS time in the control group. Conclusions. Early treatment-related BP increases do not predict clinical benefit from bevacizumab based on PFS or OS outcomes. BP increases do not appear to have general prognostic importance for patients with advanced cancer.

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