Don’t believe the headlines about Avastin

Today’s LA Times published an article that headlined “Drug is promising for ovarian cancer”. The article referred to two separate studies published in today’s New England Journal of Medicine (Dec 29,2011). My dictionary says that promising means “showing signs of future success”. I just read the articles and think their results have closed out the chances for the future.

Here is the basic information. Most cancers that arise in the ovaries (about 80%) are detected late because they don’t cause symptoms till they are large or have spread. Many attempts at developing means to detect them early have failed; there is no good screening test. The five-year survival for these women is around 30%. About 15,500 women will have died of this cancer in 2011.

So there is a definite need for better treatments. Today’s reports presented information on the drug Avastin. Avastin represents a new approach to treating cancer. It doesn’t aim for the tumor, but rather is directed against the blood vessels that supply the cancer. As the cancer grows, it needs to stimulate new blood vessels to supply it with nutrients. Avastin is designed to block this. It is controversial because it is expensive, has some serious side effect (though not more serious than other cancer therapy, only different) and hasn’t been that effective. Recently the FDA withdrew its approval of Avastin for treating breast cancer after initial successes proved temporary and were trumped by its serious side effects.

So it is a drug looking for a disease to treat. It has won approval for treating colorectal cancer and some forms of lung cancer, but even in those diseases, the results are not something to celebrate. Today’s reports on its role in ovarian cancer are likewise not something to celebrate. In fact, they are downright discouraging. In one study, from the U.S., nearly 1900 women with advanced ovarian cancer were studied; half received standard chemotherapy and the other half got Avastin in addition to the chemotherapy. It took a little longer for the cancer to progress in the Avastin group (and one must always be cautious about this because progression of ovarian cancer is often tough to spot), but after four years just as many (a little over half) of the patients who received Avastin had died, as did patients who did not get the drug.

Another study of over 1500 women with ovarian cancer was published in the same issue of the journal. This study was mainly done in Europe and had the same results. The cancer took a little more time to progress in the women given Avastin, but after 3 years, the groups had equal numbers of deaths.

What does all this mean? It means that blocking blood vessels with a drug like Avastin, though a great concept, isn’t the answer to ovarian cancer or most other cancers, unless there is a better blocker out there somewhere.

I have always said that the main treatment for cancer is surgery. All the other treatments like chemotherapy and radiation make much less difference than does surgery – cutting it all out. Ovarian cancer, as well as most other cancers, is curable if caught early. Perhaps we need to spend out money on learning how to catch, not treat.