Anne S. Tsao, MD reviewing Tiseo M et al. J Clin Oncol 2017 Jan 30.

Adding bevacizumab to cisplatin and etoposide improved progression-free survival, but not overall survival, the primary outcome.

Patients with extensive-stage small-cell lung cancer (ES-SCLC) have limited treatment options beyond first-line platinum-etoposide therapy. Early phase II trials demonstrated improvement in outcomes in this setting with the addition of bevacizumab, an antiangiogenic agent.

Now, Italian investigators have conducted a multicenter, randomized phase III trial, in which 205 treatment-naive ES-SCLC patients received cisplatin and etoposide with or without bevacizumab for 6 cycles. Nonprogressors in the bevacizumab arm received maintenance therapy for a maximum of 18 cycles.

At a median follow-up of 34.9 months, the addition of bevacizumab significantly improved median progression-free survival (PFS; 6.7 vs 5.7 months; hazard ratio, 0.72; P=0.03), but median overall survival (OS; the primary outcome) was similar with or without bevacizumab (9.8 and 8.9 months, respectively), as were overall response rates (58.4% and 55.3%). Nearly half of patients (42%) continued bevacizumab beyond 6 cycles of therapy (median, 4 cycles). Patients who received maintenance bevacizumab had improved OS (HR, 0.60; P=0.011), but not PFS. Subgroup analysis showed that bevacizumab was beneficial in men (HR. 0.55) but possibly detrimental in women (HR, 1.55; P=0.003).

CITATION(S):

Tiseo M et al. Italian, multicenter, phase III, randomized study of cisplatin plus etoposide with or without bevacizumab as first-line treatment in extensive-disease small-cell lung cancer: The GOIRC-AIFA FARM6PMFJM trial. J Clin Oncol 2017 Jan 30; [e-pub]. 

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