Author of

• 11692

  +

  P2.10 - Poster Session 2 - Chemotherapy (ID 207)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Medical Oncology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11731

    +

    P2.10-039 - Outcomes of first line bevacizumab-based chemotherapy for NSCLC relative to the medications used to control hypertension (HTN). (ID 2517)

    09:30 - 09:30  |  Author(s): M. Mahan
    • Abstract

    Background
    Several studies have suggested a correlation between development of hypertension and response to bevacizumab therapy. Most studies have suggested a prolongation of progression free survival and possibly overall survival in patients who develop emergent hypertension during therapy. Preclinical data suggests an interaction between the renin-angiotensin “RA” system and the vascular endothelial growth factor (VEGF) system. This interaction between the two systems may lead to activation of the RA system when the VEGF system is inhibited. Studies have suggested an activated RA system induces a pro-proliferative response in tumor tissue. We hypothesize that this interaction between the RA and VEGF systems results in a differential response to VEGF therapy when angiotensin modifying drugs (AMD) are used in the treatment of bevacizumab induced HTN.

    Methods
    We evaluated patients treated at our institution with bevacizumab containing chemotherapy in the first line setting for locally advanced or metastatic non small cell lung cancer and continued bevacizumab therapy until progression, development of adverse events or death. The primary endpoint was Time to Treatment Failure (TTF) defined as the time from initiation of bevacizumab therapy until discontinuation for progression, adverse events or death. Patients were compared based on history of preexisting HTN, emerging HTN, exposure to antihypertensive drugs (AHD) or exposure to AMD (ace inhibitors “ACEi” or angiotensin receptors blockers “ARB”)

    Results
    75 patients met the inclusion criteria. 38 patients (51%) had preexisting hypertension, 41 (55%) patients were taking an antihypertensive drug prior to the start of chemotherapy and 24 (32%) patients developed emergent hypertension. The median TTF for patients with emergent HTN was 13.1(95% CI: 10.1, 19.9) months versus for those without exposure to AHD was 4.7 (95% CI: 3.5, 5.6) months (p= 0.076). The median TTF for patients with HTN who were treated with AMD was 4.9 (95% CI: 29, 7.5) months compared to 6.2( 95% CI:4.0, 12.3) months for patients treated with all other AHD ( P=0.716) and 4.7( 95% CI:3.5, 5.6) months for patients without exposure to AHD (p=0.438).

    Conclusion
    We did not observe a statistically significant difference in TTF between any of the groups studied. We specifically did not observe an advantage to using an AMD over other AHDs for the treatment of HTN during bevacizumab therapy. We did observe a trend towards longer TTF in patients who developed emergent HTN commensurate to currently published data.