Willett and Jain reply:
The objective of our study was to examine the biological and clinical effects on rectal cancer of an initial bevacizumab infusion, before the initiation of radiation therapy and 5-fluorouracil. Six patients with clinical stage T3 or T4 rectal cancer completed the neoadjuvant therapy consisting of the first bevacizumab infusion followed by three 2-week cycles of bevacizumab administered concurrently with external beam radiation therapy (50.4 Gy in 28 1.8-Gy fractions over 5.5 weeks) and 5-fluorouracil (225 mg/m2/24 h by continuous peripheral venous infusion). Effects of the combined treatment on tumors were evaluated before surgery endoscopically and by PET scan and perfusion CT scan. Details of the protocol may be found in a corrigendum to our article, printed in this issue1. The 18-fluorodeoxyglucose uptake in the neck seen on one representative sagittal image of the presurgery PET scan (patient 1 in the original figure) was, in fact, seen on all three PET scans (pretreatment, day 12 and presurgery) and was interpreted as upper-limit normal activity in the thyroid gland. This PET finding was not judged to represent a metastasis, and similarly, PET findings showed no detectable evidence of metastasis in any of the other five patients (see Fig. 1 below). Although the goal of this study was to examine the biological and clinical response to a single dose of bevacizumab, the longer-term results of combined therapy in six consecutive patients have been promising.
See “PET concerns in bevacizumab treatment” by Goessl and Grozdanovic.
References
Willett, C.G. et al. Nat. Med. 10, 649 (2004).
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Willett, C., Duda, D., Fischman, A. et al. Reply to “PET concerns in bevacizumab treatment”. Nat Med 10, 561 (2004). https://doi.org/10.1038/nm0604-561b
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DOI: https://doi.org/10.1038/nm0604-561b