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Avastin Before or After Chemotherapy

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Last Modified: April 8, 2007

Dear OncoLink "Ask The Experts,"

Is there a therapeutic advantage to giving Avastin first or last in a regimen?

Bruce Giantonio, MD, Assistant Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania, responds:

I am not aware of any clinical data that argues for one over the other, i.e. for a benefit to giving it either first or last within the treatment regimen. In the clinical trial E3200, we specified that the bevacizumab (Avastin) be given first, but that was to provide consistency and not for any other reason. However, based on the 'pseudo-normalization' hypothesis of anti-VEGF (anti-angiogenesis) therapy, it is possible that administering the bevacizumab prior to the chemotherapeutic drugs could potentially enhance delivery of the chemotherapy into the tumor.