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Question about Alimta and Avastin Combination for Advanced NSCLC patient

Due to extreme neuropathy, my mother’s oncologist is wanting to start my mother on Alimta since it has recently been approved for first line therapy. The problem is that a couple months ago, her oncologist added the chemo drug Avastin. At first, her oncologist did not want to have her on both chemo drugs (Avastin and Alimta), as there is a contraindication between the two. After a CT scan of lung and MRI on brain showed growth of tumors in both areas, the oncologist now thinks the Alimta/Avastin combination is worth the risk of the contraindication. What my understanding of this contraindication is that it has resulted in hemorrhaging of 25% of patients that this treatment has been used on of primary brain cancer patients. The oncologist could not give us any statistics as there have been no studies on patients in my mother’s situation. The studies have only been done on those with primary brain cancer.

So my family is faced with this decision: go ahead with the Alimta/Avastin combination and risk brain hemorrhage for the chance at more time, or forgo the Avastin and possibly have less a chance at her surviving longer.

My family feels so incredibly uninformed to make any such decision and my mother’s oncologist is not adequately able to answer our questions (plus, we only ever get to see her for about 20 minutes every 3 weeks since she has so many patients).

So, our question is: what significant benefit would this combination have? I know it can only be a guess, but do you think the time it could buy her would be significant? A couple more months, six months? We just don’t know if it’s worth the risk of possible bleeding in the brain. Our main concern is that she be as comfortable as possible. Do you know of other adverse effects from this option? I would certainly appreciate if it’s at all possible that you could send the pro’s and con’s of using these two drugs together.

Thank you for your time,

Jessica Cummins

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  • 1 Answer(s)

    Hi,
    Its true that not much data is available although there are a few ongoing clinical trials studying the effects of a combination of Avastin+Alimta+Paclitaxel / Gemcitabine. The risk of a severe haemorrhagic event wth Avastin is between 1.2 to 4.6% in various trials. A recent study evaluated the efficacy and safety of pemetrexed (Alimta), carboplatin, and bevacizumab (Avastin) followed by maintenance pemetrexed and bevacizumab in patients with stage IIIB (effusion) or stage IV nonsquamous non–small-cell lung cancer:(NSCLC). http://jco.ascopubs.org/cgi/content/abstract/27/20/3284
    In this study, the 55% patients had some response. The toxicity was modest and there was no severe hemorrhagic event. You may access the abstract of this study on the link I have pasted above.
    All the best

    Answered on May 11, 2014.
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