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30-08-2019 | Non-small-cell lung cancer | News

No survival benefit with erlotinib–bevacizumab in stage IV NSCLC

medwireNews: Adding bevacizumab to erlotinib does not improve the outcomes of previously untreated patients with EGFR mutation-positive advanced non-small-cell lung cancer (NSCLC), finds a phase II trial.

Speaking to medwireNews, Howard (Jack) West (City of Hope Comprehensive Cancer Center, Duarte, California, USA) commented that the erlotinib–bevacizumab combination “had no meaningful traction even before this publication,” which has just crystallized the lack of a role.

He noted that “the data with erlotinib/ramucirumab from the RELAY trial are more compelling, but the greatest focus is on chemotherapy and EGFR–TKI [tyrosine kinase inhibitor] combinations, in the wake of the very positive trials” presented at last and this year’s ASCO Annual Meeting.

“The greatest interest for a combination is with chemotherapy/osimertinib, and these trials are just getting started in earnest,” said West.

In the current trial comprising 88 individuals with treatment-naïve stage IV NSCLC positive for an EGFR exon 19 deletion or exon 21 L858R mutation, the addition of bevacizumab 15 mg/kg every 3 weeks to erlotinib 150 mg/day did not significantly improve the primary endpoint of progression-free survival, at a median of 17.9 and 13.5 months for the combination and erlotinib alone groups, respectively.

The objective response rate was likewise comparable between participants who received erlotinib plus bevacizumab and those given erlotinib alone (81 vs 83%), and median overall survival (OS) also did not differ significantly between arms (32.4 vs 50.6 months).

Lead author Thomas Stinchcombe (Duke Cancer Institute, Durham, North Carolina, USA) and colleagues say that subsequent therapies are unlikely to have affected the OS results as these were similar across the groups, and a comparable proportion of patients in both arms received second-line osimertinib.

Writing in JAMA Oncology, the researchers note that “the treatment landscape for EGFR-mutant NSCLC has changed” since the initiation of this trial, with osimertinib becoming “the preferred first-line therapy.”

“Consequently, there is interest in combining osimertinib with bevacizumab as first-line therapy,” and trials of the combination are ongoing, they say.

By Shreeya Nanda

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

JAMA Oncol 2019; doi:10.1001/jamaoncol.2019.1847