title: Bevacizumab as first-line treatment in HER2-negative advanced breast cancer: pros and cons.
abstract: OBJECTIVE
  Bevacizumab, a humanized, anti-vascular endothelial growth factor-A monoclonal antibody, has shown efficacy in a number of cancers. However, its use in metastatic breast cancer (MBC) remains controversial.
  
  
  METHODS
  A literature review using the PubMed database was performed to update the currently available clinical trials evidence on bevacizumab in the first-line treatment of breast cancer. In addition, the proceedings of selected oncology annual meetings were searched for relevant presentations.
  
  
  RESULTS
  This article reviews the available evidence for bevacizumab as first-line therapy for MBC and discusses its current and future applicability in the management of MBC. Three phase III trials (ECOG-2100, AVADO, RIBBON-1) demonstrated that the addition of bevacizumab to chemotherapy is well-tolerated and improves progression-free survival and objective response rates in the first-line setting. These findings were supported by a large clinical practice-based study (ATHENA) and a recent clinical trial in which bevacizumab added to paclitaxel showed notable activity in triple-negative MBC. However, bevacizumab has thus far not demonstrated a significant benefit in overall survival.
  
  
  CONCLUSIONS
  The addition of bevacizumab to chemotherapy is well-tolerated and produces substantial improvements in overall response rate and progression-free survival, compared with chemotherapy alone, in advanced HER2-negative breast cancer. Nevertheless, it has thus far not demonstrated a significant benefit in overall survival. Whether prolongation of progression-free survival is enough to consider bevacizumab efficacious is unclear. Based on the available clinical trials results, bevacizumab is a part of the complex therapeutic strategy of advanced HER2-negative breast cancer.
authors.affiliation:  Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, and Oncology Unit ASL Roma 1 Santo Spirito Hospital, Rome - Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sini
authors.affiliation:  Division of Medical Oncology, Catholic University of Sacred Heart, Rome - Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cassano
authors.affiliation:  Oncology Unit, San Giovanni Calabita Hospital, Rome - Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Corsi
authors.affiliation:  Department of Breast Oncology, National Cancer Institute "Fondazione Pascale," Naples - Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Laurentiis
authors.affiliation:  Medical Oncology Unit ASL Frosinone, Frosinone - Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
authors.affiliation:  Oncology Unit, San Giovanni Hospital, Rome - Italy.
authors.forename: Mariella
authors.initials: M
authors.lastname: Mauri
authors.affiliation:  Oncology B Unit, Sapienza University of Rome, Rome - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Naso
authors.affiliation:  Oncology Unit, Tor Vergata University of Rome, Rome - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Roselli
authors.affiliation:  Division of Medical Oncology, Belcolle Hospital, ASL Viterbo, Viterbo - Italy.
authors.forename: Enzo Maria
authors.initials: EM
authors.lastname: Ruggeri
authors.affiliation:  Department of Medical Oncology, University Campus Bio-Medico, Rome - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
authors.affiliation:  Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome - Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.affiliation:  Oncology Unit, Nuovo Regina Margherita Hospital, Rome - Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Zampa
authors.affiliation:  Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, and Oncology Unit, IDI-IRCCS, Rome - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism* / Q000473:pathology; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy; D009367:Neoplasm Staging; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000172:deficiency*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000068258:Bevacizumab; D018719:Erb-b2 Receptor Tyrosine Kinases