avastin only maintenance?

I will be having my 6th and last cycle of avastin and alimta chemo on the 30th. Now, my onc is telling me that if my ct scan results will be stable. My tumor at 2.2 cm , have pleural thickening on the right pleura, nothing on other organs(thank God) he plans on giving me maintenance of avastin and alimta. I ask him whether can be Avastin only, he refused. Now, am planning to insist on Avastin only, not only because of financial burden(additional $3,000)but also possible additional toxicity. If Hongkong medical board will approve, am also planning to shift to Afatinib with Erbitux. Anybody has idea what possible better step to take? Had undergone blood biopsy in Germany by Biofocus and the result says Alimta not suitable for me and only small percentage for Avastin. Am feeling fine except for SOB when exerting a little effort but can go around on wheel chair

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My father was given at Memorial Sloan Ketering in New York six rounds of carbo/alimta/avastin with great response, the oncologist suggested to move to avastin alone, our local oncologist suggested 3 more rounds of avastin/alimta and then to move to avastin alone. We proceeded with this compromise and he's scans remain very good on avastin alone. I have asked a couple of times how do they decide to give avastin alone or in combination with alimta however I have not gotten any good answers.
My father was diagnosed with stage IV NSCLC last April after having found water in his lung. Luckily no mets found anywere. He did undergo a pleuradesis (talk procedure) in April when they completed the biopsy to prevent the liquid from forming again. I have learned recently (on this page, there is a discussion on fluid in your lungs which has all the links to the research) that the talc has been proven to help fight the cancer.
What stage are you? Where are your tumors? Have your oncologist look at talk procedures which could help your issues with the pleura.
Best of luck!!!

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Yes, I had pleurodesis done in Feb that's why my pleural lining thickened more by May because I stayed with Tarceva and did not have chemo until after petct showed pleural thickening worsened. It stayed the same in July petct after the chemo of avastin, alimta and carbo. I will try to talk to my onco again after my 6th cycle. Thanks for the info. am stage iv also because of the pleural effusion. My tumor is only in my middle right lobe. My SUV is 4. Plus. I am hoping that Avastin will keep my tumor stable if not shrink some more. Thanks for your reply!

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There is no right answer currently of what is best; alimta, alimta & avastin or avastin. Clincial trial ECOG 5508 should answer the question.


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Clinical trials have shown, and there is a theoretical extrapolation from cell culture data that explains, why the combination of cytotoxic chemotherapy with Avastin generally works better than either alone. The mechanism of antagonism is a bioenergetically active process.

When you culture endothelial cells with Avastin, all the VEGF (which is involved in angiogenesis) gets pulled out of the culture medium and the endothelial cells undergo what is called massive calcium accumulation death. Cytotoxic anti-cancer drugs antagonize the ability of Avastin to kill endothelial cells through this specific cell death mechanism.

This is because Avastin has a very long half life (weeks) and it has the opportunity to work at times when the drug levels of the standard cytotoxic anti-cancer drugs go down to undetectable levels (where they won't antagonize the ability of low VEGF to cause death of the tumor endothelial cells).


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Thank you very much Shane and Greg for your reply. It will really make a difference in our final decision to what chemo drugs to have later.

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Hi Greg - when you say drugs like alimta antagonizes avastins. Ability to kill cancer cells, do u mean it helps r does not help kill cancer cells? Thanks

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I didn't post that about Alimta on this thread. However, on the subject of Alimta, it is a small molecule, folate antagonist (potentiating) drug that can cross the blood-brain barrier. In regards to antagonists, they are substances that attach to a receptor but does not activate it or if it displaces an agonist (a substance that fully activates a receptor) at that receptor, it deactivates it, thereby reversing the effect of the agonist.

Can Alimta antagonize Avastin? What I can show you as an example is that Tykerb (a small molecule like Altima) can enhance the antivascular activity of Avastin.

http://www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&conf ID=58&abstractID=40418

If you like to look at the slide presentation (it is a large download 25.65 MB)



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Thanks, Greg, for the great explanation as to why Avastin is used in conjunction with another chemotherapeutic agent.......

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FWIW, if it were me, I'd go for the combo for as long as I could tolerate it well for all the reasons already discussed, and because I've heard one or two other people on this forum say they had Avastin+Alimita maintenance, too.

Best hopes,

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Thanks Craig, that is what my onc wants if ever we will not be able to get the Afatinib

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