1160P - A phase II trial of bevacizumab with capecitabine in progressive, metastatic well-differentiated digestive endocrine tumors (better study)

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anticancer agents
Neuroendocrine Cancers
Biological therapy
Presenter Thomas A. Walter
Authors T.A. Walter1, E. Baudin2, J.E. Kurtz3, P. Ruszniewski4, L. Bengrine-Lefevre5, G. Cadiot6, S. Dominguez-Tinajero7, S. Kraemer8, M. Ducreux9, E. Mitry10
  • 1Oncologie Médicale, Hôpital Edouard Herriot, Lyon/FR
  • 2Oncologie, Institut Gustave Roussy, Villejuif/FR
  • 3Oncologie Et Hématologie, Hôpitaux Universitaires, Strasbourg/FR
  • 4Gastro-entérologie, Hôpital Beaujon, Clichy/FR
  • 5Oncologie Médicale, Hôpital Saint-Antoine, Paris/FR
  • 6Gastro-entérologie Et Hépatologie, Hôpital Robert Debré, Reims/FR
  • 7Oncologie - Pathologie Digestive, Centre Oscar Lambret, Lille/FR
  • 8Biostatistique, Laboratoires Roche, Boulogne-Billancourt/FR
  • 9Oncologie Digestive, Institut de Cancérologie Gustave Roussy, 94805 - Villejuif/FR
  • 10Oncologie Médicale, Institut Curie, Paris/FR



We assessed bevacizumab (Bv), a monoclonal antibody directed against VEGF, combined with capecitabine (CAP) in neuroendocrine digestive tumors (NET) known to be highly vascularized neoplasms Demographics and primary endpoint (PFS) will be presented at ASCO 2012 (abstract#4071). Here we emphasize on response (central review), PP analysis and safety data.


BETTER is a multicenter, open-label, non-randomized, two-group phase II trial. Patients (pts) with progressive, metastatic well-differentiated digestive tract endocrine tumors (WHO 2000 classification), ECOG-PS ≤2, Ki 67 index < 15%, no prior systemic chemotherapy were treated with Bv (7.5 mg/m2 on d1/3 weeks) and CAP (1000 mg/m2 twice daily, orally d1-14, resumed on day 22). Pts were treated for ≤6 months, up to 24 months. Efficacy (PFS, overall survival [OS], response rate), safety and quality of life were assessed.


In the ITT population (n = 49), 26 (53.1%) pts were men; median age 60.3 years (41.2-82.3); ECOG-PS was 0/1 in 46 (93.9%) pts. Primary tumor site was mainly small intestine 40 (81.6%) pts. Ki-67 proliferative index was 0-2% in 17 (35.4%) pts and 3-14% in 31 (64.6%). After a maximum of 24 months of follow-up per patient, median PFS assessed by investigators was 23.4 months [95%CI: 13.2; not reached] based on 26 events. Centrally reviewed tumor control rate was 93.8% (n = 45) including partial response in 6 (12.5%) pts and stable disease in 39 (81.3%) pts (1 missing and 3 not evaluable), comparable to investigators assessment. Survival rate at 24 months was 85%. Median OS was not reached. All efficacy results were similar in the ITT and PP populations. CTC grade 3/4 Adverse Events (AEs) occurred in 41 (83.7%) pts, mainly digestive 14 (28.6%) pts. Main G3/4 AE of special interest to BV was hypertension in 15 (30.6%) pts. Eight patients died: 3 of disease progression, 2 of AEs (stroke, peritonitis) and 3 for other reasons (Parkinson disease, liver transplantation/septicemia, cardiac arrest).


In this phase II study assessing Bv and CAP in a chemotherapy resistant tumor; such encouraging results suggest that this combination may become a good alternative in the treatment of ileal NET.


E. Mitry: Honoraries: Roche.

E. Baudin: Honoraries: Scientific committee of BETTER Trial.

P. Ruszniewski: Consultant: Ipsen, Novartis, Pfizer Honoraries: Ipsen, Novartis, Pfizer. Clinical research project: Ipsen, Novartis, Pfizer.

G. Cadiot: Honoraries: Novartis, Ipsen, Pfizer Other financing (please detail): Novartis, Ipsen, Pfizer.

S. Kraemer: Employment: Roche.

M.P. Ducreux: Consultant: Roche, Merck Serono Honoraries: Roche, Merck Serono, Amgen, Bayer, Fresenus, Pfizer, Sanofi Clinical research project: Pfizer, Chugai, Merck Serono.

All other authors have declared no conflicts of interest.