Long Term Maintenance Therapy with VEGF Inhibitor with Remission of the Disease for Seven Years in Patient with Metastatic Rectal Cancer

Ocvirk Janja

doi:10.19080/jojcs.2018.09.555778

Abstract

We report a case of a 65-year-old female with metastatic rectal adenocarcinoma which was on maintenance therapy with bevacizumab from September 2007 to September 2014. For seven years she was in remission. At that time except for the hoarseness that developed after three years of maintenance therapy with bevacizumab, no additional changes were noted. Bevacizumab is a monoclonal antibody, a VEGF inhibitor. Neutralizing the biological activity of VEGF regresses the vascularisation of tumours, normalises remaining tumour vasculature, and inhibits the formation of new tumour vasculature, thereby inhibiting tumour growth. The use of maintenance therapy with bevacizumab in patients with metastatic colorectal cancer is widely accepted, but the duration of maintenance is not yet defined. The side effects of bevacizumab as maintenance therapy remains to be answered. The individual treatment approach is the best way of treating the patient, and in the lack of definite data of the biology of the individual metastatic carcinoma, the multidisciplinary approach and the experienced specialists are essential..

Highlights

Bevacizumab is a monoclonal antibody, which binds to VEGF, the key driver of neovascularization, and thereby inhibits the binding of VEGF to its receptors, VEGFR-1 and VEGFR-2, on the surface of endothelial cells
We report a case of a patient, with metastatic adenocarcinoma of the rectum, on maintenance therapy with bevacizumab from September 2007 till September 2014, being in disease remission for seven years, and only with dysphonia as side effect
The progression free survival (PFS) significantly improved in the Bevacizumab + XELOX arm compared with the chemotherapy alone arm (9.3 months vs 7.4 months, hazard ratio HR 0.77, p=0.0026)

Summary

Introduction

Bevacizumab is a monoclonal antibody, which binds to VEGF, the key driver of neovascularization, and thereby inhibits the binding of VEGF to its receptors, VEGFR-1 and VEGFR-2, on the surface of endothelial cells. The control CT of the thorax and abdomen has showed partial response of the disease in the left scl and in the liver, so the metastasectomy of the liver mets followed in March 2007 She continued with two additional cycles of XELIRI + bevacizumab till May 2007. After one month the condition has normalized, the hearth function remained normal (EF LV 55%) and as the control CT of the thorax and abdomen showed further regression of the disease in the left scl, she received two additional cycles of XELIRI combined with bevacizumab. Afterwards she continued with maintenance monotherapy with bevacizumab. In September 2014 the progression of the disease in the lymph nodes of the neck and in the abdomen as in the liver was diagnosed and the treatment with bevacizumab was discontinued

Findings

Discussion

Conclusion