RIBBON-1: Randomized, Double-Blind, Placebo-Controlled, Phase III Trial of Chemotherapy With or Without Bevacizumab for First-Line Treatment of Human Epidermal Growth Factor Receptor 2–Negative, Locally Recurrent or Metastatic Breast Cancer

• Published in: Journal of clinical oncology Vol. 29; no. 10; pp. 1252 - 1260
• Main Authors: ROBERT, Nicholas J, DIERAS, Véronique, PHAN, See-Chun, O'SHAUGHNESSY, Joyce, GLASPY, John, BRUFSKY, Adam M, BONDARENKO, Igor, LIPATOV, Oleg N, PEREZ, Edith A, YARDLEY, Denise A, CHAN, Stephen Y. T, XIAN ZHOU
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Society of Clinical Oncology 01-04-2011
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Biomarkers, Tumor - analysis; Breast Neoplasms - chemistry; Breast Neoplasms - drug therapy; Breast Neoplasms - mortality; Breast Neoplasms - secondary; Chi-Square Distribution; Disease-Free Survival; Double-Blind Method; Europe; Female; Humans; Kaplan-Meier Estimate; Middle Aged; Neoplasm Recurrence, Local; Placebo Effect; Proportional Hazards Models; Receptor, ErbB-2 - analysis; Risk Assessment; Risk Factors; Survival Rate; Time Factors; Treatment Outcome; United States; Young Adult; United States; Europe
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2010.28.0982

This phase III study compared the efficacy and safety of bevacizumab (BV) when combined with several standard chemotherapy regimens versus those regimens alone for first-line treatment of patients with human epidermal growth factor receptor 2-negative metastatic breast cancer.
Patients were randomly assigned in 2:1 ratio to chemotherapy plus BV or chemotherapy plus placebo. Before random assignment, investigators chose capecitabine (Cape; 2,000 mg/m(2) for 14 days), taxane (Tax) -based (nab-paclitaxel 260 mg/m(2), docetaxel 75 or 100 mg/m(2)), or anthracycline (Anthra) -based (doxorubicin or epirubicin combinations [doxorubicin/cyclophosphamide, epirubicin/cyclophosphamide, fluorouracil/epirubicin/cyclophosphamide, or fluorouracil/doxorubicin/cyclophosphamide]) chemotherapy administered every 3 weeks. BV or placebo was administered at 15 mg/kg every 3 weeks. The primary end point was progression-free survival (PFS). Secondary end points included overall survival (OS), 1-year survival rate, objective response rate, duration of objective response, and safety. Two independently powered cohorts defined by the choice of chemotherapy (Cape patients or pooled Tax/Anthra patients) were analyzed in parallel.
RIBBON-1 (Regimens in Bevacizumab for Breast Oncology) enrolled 1,237 patients (Cape cohort, n = 615; Tax/Anthra cohort, n = 622). Median PFS was longer for each BV combination (Cape cohort: increased from 5.7 months to 8.6 months; hazard ratio [HR], 0.69; 95% CI, 0.56 to 0.84; log-rank P < .001; and Tax/Anthra cohort: increased from 8.0 months to 9.2 months; HR, 0.64; 95% CI, 0.52 to 0.80; log-rank P < .001). No statistically significant differences in OS between the placebo- and BV-containing arms were observed. Safety was consistent with results of prior BV trials.
The combination of BV with Cape, Tax, or Anthra improves clinical benefit in terms of increased PFS in first-line treatment of metastatic breast cancer, with a safety profile comparable to prior phase III studies.