Efficacy/tolerability of 2nd-line aflibercept vs bev beyond PD
How would you compare the efficacy of aflibercept to the use of bevacizumab on disease progression in the second-line setting?
How would you compare the side effects and tolerabilty of aflibercept to the use of bevacizumab on disease progression in the second-line setting?
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Steven R Alberts, MD, MPH |
| Chair, Division of Medical Oncology Professor of Oncology Mayo Clinic Rochester, Minnesota |
The published data suggest that aflibercept and bevacizumab as second-line therapy are fairly comparable in terms of benefit. However, it is dangerous to compare between studies.
From the published data, I believe that bevacizumab is potentially more tolerable than aflibercept in the second-line setting.
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Al B Benson III, MD |
| Professor of Medicine Associate Director for Clinical Investigations Robert H Lurie Comprehensive Cancer Center of Northwestern University Chicago, Illinois |
In terms of efficacy, I believe that aflibercept and bevacizumab are interchangeable. So, if someone is tolerating bevacizumab well, there is no reason to switch to aflibercept.
Going by the available data, the tolerability of aflibercept is of concern.
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Charles S Fuchs, MD, MPH |
| Director Center for Gastrointestinal Cancer Dana-Farber/Harvard Cancer Center Professor of Medicine Harvard Medical School Boston, Massachusetts |
In terms of efficacy, I believe that aflibercept and bevacizumab as second-line therapy are equivalent. Based on cross-trial comparisons, I am not convinced that they are different.
Considering all the limitations of cross-trial comparisons, the VELOUR trial results suggest that aflibercept may be associated with greater toxic effects.
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Richard M Goldberg, MD |
| Professor of Medicine Physician-in-Chief, OSUCCC - James Cancer Hospital and Richard J Solove Research Institute Klotz Family Chair in Cancer Research The Ohio State University Columbus, Ohio |
Based on my clinical experience, it is difficult to compare the efficacy of these agents. Due to the differences in the population of patients enrolled on the TML and VELOUR studies, it is hard to compare the efficacy of bevacizumab to that of aflibercept. In my mind, I see the agents as being equally effective, but that’s an opinion that is not based on data.
Most oncologists have a much longer and larger experience with bevacizumab than with aflibercept. Although data from the VELOUR trial suggested that aflibercept might be associated with more toxicities than bevacizumab, that has not been my experience in clinical practice. I have found aflibercept to be equally tolerable to bevacizumab in the second-line setting.
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Axel Grothey, MD |
| Professor of Oncology Department of Medical Oncology Mayo Clinic Rochester, Minnesota |
Comparing the efficacy of aflibercept to bevacizumab beyond disease progression in the second-line setting, I believe the efficacy is about the same.
I believe bevacizumab is more tolerable than aflibercept. As I previously mentioned, more diarrhea, febrile neutropenia and asthenia occur with aflibercept.
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Howard S Hochster, MD |
| Associate Director (Clinical Research) Yale Cancer Center Professor of Medicine Yale School of Medicine New Haven, Connecticut |
Based on the available data, the efficacy of aflibercept and bevacizumab beyond disease progression in the second-line setting appear to be equivalent.
In terms of toxicity, aflibercept seems to be associated with more toxicity in comparison to bevacizumab. Anecdotally, I’ve heard from several people that a lot more mucositis is associated with aflibercept.
However, comparing data between 2 different studies is unfair because patients on the TML study of bevacizumab beyond disease progression were allowed to continue treatment with dose reductions whereas those on the VELOUR trial of aflibercept started at full doses. So I believe the deck is stacked against aflibercept, although it seems to induce more mucositis.
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Herbert I Hurwitz, MD |
| Associate Professor of Medicine Division of Hematology/Oncology Clinical Director, Phase I Program Co-leader, GI Oncology Program Duke University Medical Center Durham, North Carolina |
In terms of efficacy, I believe that the efficacy of aflibercept versus bevacizumab beyond disease progression in the second-line setting is about the same.
I believe that bevacizumab is a little more tolerable than aflibercept, based on the available data. However, the toxicity profiles of the 2 agents may have been affected by the chemotherapy regimens with which they were combined.
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Wells A Messersmith, MD |
| Professor and Director GI Medical Oncology Program Co-Leader Developmental Therapeutics Program University of Colorado Cancer Center Aurora, Colorado |
I believe the efficacy results are similar for bevacizumab and aflibercept in the second-line setting. However, I believe that the toxicity profile for aflibercept is worse.