AP: In colon cancer drug study, more wasn't better

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In colon cancer drug study, more wasn't better

By STEPHANIE NANO, Associated Press Writer Nano, Associated

Press Writer – 20 mins ago

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NEW YORK – Doctors thought that combining two newer drugs that more

precisely attack cancer would help people with advanced colon cancer.

Instead, it made the cancer worse and made the patients more miserable,

a study found. The surprising findings underscore the importance of

doing rigorous studies before rushing to mix these pricey,

new-generation drugs, the Dutch researchers and other experts said.

The doctors tried combining Erbitux and Avastin because lab tests and an

earlier small study had shown promising results.

" This will stand out as a warning, " said Dr. Cornelis Punt, the study's

leader. " You have to do the randomized studies to see what really

happens. "

For the study, Eli Lilly & Co.'s Erbitux was added to standard

treatment, which includes Genentech Inc.'s Avastin. Since both are

" targeted " drugs and attack tumors in different ways, the thinking was

that the combo would do a better job of keeping the cancer from growing.

But the results show " more is not always better, " said Dr. Mayer,

of Dana-Farber Cancer Institute in Boston. He wrote an editorial

published with the study in Thursday's New England Journal of Medicine.

What makes the results even more compelling, Mayer said, is that another

similar study reached the same conclusion. That study, released in

December, tested another targeted drug that works the same way as

Erbitux.

" This is the first time we've seen harm by combining targeted therapies

and it tells us we need to be cautious, " said Dr. Jordan Berlin, a

gastrointestinal cancer specialist at Vanderbilt-Ingram Cancer Center in

Nashville, Tenn.

Berlin, who had no role in the research, stressed that the drugs do help

patients, just not when given together.

Colorectal cancer is the nation's second leading cancer killer. The

disease was expected to kill almost 50,000 Americans last year although

death rates are dropping because of screening and better treatment.

The research was done at hospitals throughout the Netherlands and led by

Punt at Radboud University Nijmegen Medical Center. The 755 study

patients had colon cancer that had spread. They all received Avastin,

also known as bevacizumab, and two chemotherapy drugs. Half of them also

got Erbitux, also called cetuximab. They were followed for nearly two

years.

The group that got Erbitux saw their cancer get worse sooner, the

researchers found. On average, their cancer progressed after 9.4 months

compared to 10.7 months for those who didn't get Erbitux. The Erbitux

group also had lower quality-of-life scores.

The overall survival in both groups was about the same.

Punt said they are now trying to figure out why the combo didn't work;

it could be an interaction between these two specific drugs, Erbitux and

Avastin.

After the study began in 2006, it was shown that Erbitux didn't help

colon cancer patients who had a specific gene mutation. The Dutch

researchers said their study confirmed that — the worst results were

in those with the mutation who got Erbitux.

Vanderbilt's Berlin said the results also show doctors need to be

careful when using drugs " off-label. " Drugs are approved for specific

uses but doctors can prescribe them for other purposes. Medicare has

recently expanded its coverage for such use of some cancer drugs, which

can cost thousands a month.

Off-label use " needs to be cautious and this proves it, " said Berlin.

The study was supported by a network of Dutch researchers which receives

grants from a cancer foundation and drug companies. The two targeted

drugs were provided by the companies that market them in Europe. Several

of the researchers have consulted for cancer drug companies, as has the

editorial writer and Berlin.