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Blogger's Note: reposted from Jan 20th due to Lancet Editorial and reference - paper is open accdess
pay specific attention to patient safety/adverse events;
related article on the (beneficial) use of Aflibercept in colorectal cancer patients (Aflibercept Improves Survival In Metastatic Colon Cancer - December 2011)
Intravenous aflibercept for treatment of recurrent symptomatic malignant ascites in patients with advanced ovarian cancer: a phase 2, randomised, double-blind, placebo-controlled study Aflibercept
Interpretation
This
study shows the effectiveness of VEGF blockade in the reduction of
malignant ascites, but confirms the significant clinical risk of fatal
bowel perforation in this population of patients with very advanced
cancer. VEGF blockade should be used with caution in advanced ovarian
cancer with abdominal carcinomatosis, and the benefit—risk balance
should be thoroughly discussed for each patient.
"In view of the important pathogenetic role of VEGF in ascites formation,
the efficacy of VEGF inhibitors have also been assessed in patients
with symptomatic malignant ascites. Confirming the results of a recent
open-label single-arm phase 2 trial,6 the randomised double-blind placebo-controlled study by Walter Gotlieb and colleagues7 in The Lancet Oncology
shows the efficacy of aflibercept in patients with malignant ascites
associated with advanced ovarian cancer and can be interpreted as proof
of concept. The intervention and the control groups were homogenous,
confounding variables controlled, and bias reduced. Therefore, the study
has a high internal validity and shows the efficacy of aflibercept.
With respect to the clinical implications of the results, symptom relief
has to be weighed against discomfort and potentially life-threatening
adverse events (three patients had fatal gastrointestinal complications
in the aflibercept group vs one in the placebo group), since the
treatment is applied to patients in a highly palliative situation.
Careful patient selection could reduce the incidence of gastrointestinal
perforations. However, before a general recommendation of aflibercept
for the treatment of malignant ascites can be made, further studies,
including comparative effectiveness research,8 (Blogger's Note: AND patient safety) are needed to compare the effectiveness of the different therapeutic strategies in daily clinical practice."
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