Serum LDH may predict metastatic CRC bevacizumab benefit after progression
medwireNews: Baseline levels of serum lactate dehydrogenase (LDH) could help select the patients with metastatic colorectal cancer (CRC) who are most likely to benefit from continuing bevacizumab after progressing on first-line therapy.
The Italian research team identified a significant interaction effect between serum LDH and treatment among 159 participants of the phase III BEBYP trial that randomly assigned patients who progressed after treatment with fluoropyrimidine-based chemotherapy plus bevacizumab to receive a different chemotherapeutic regimen either with or without bevacizumab.
Participants with low (<300 UI/L) LDH levels benefited from the addition of second-line bevacizumab, with a median progression-free survival (PFS) of 9.0 months versus 4.6 months for chemotherapy alone (hazard ratio [HR]=0.39].
However, there was no significant difference between treatment arms among patients with higher LDH concentrations, with corresponding median PFS times of 5.5 and 5.0 months (HR=1.10).
The findings were similar for overall survival, but the interaction effect did not reach statistical significance, a finding that Alfredo Falcone, from the University of Pisa, and co-researchers attribute to the low power of this secondary analysis and the potential confounding effects of later-line therapies.
They write in the British Journal of Cancer: “As preclinical evidence suggests that serum LDH may be a marker of tumour angiogenesis activation, low levels may indicate that bevacizumab is still efficacious in inhibiting angiogenesis.”
Highlighting that their results are “hypothesis-generating”, Falcone et al stress the importance of validating them in “subgroup analyses of other randomised trials of second-line angiogenesis inhibitors.”
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