The addition of bevacizumab to first-line treatment with cisplatin plus etoposide significantly improved progression-free survival, but not overall survival, with an acceptable toxicity profile in patients with extensive-disease small-cell lung cancer (SCLC), a study published in the Journal of Clinical Oncology has shown.1
Phase 2 studies have demonstrated encouraging efficacy with bevacizumab in combination with cisplatin and etoposide in extensive-disease SCLC. Therefore, researchers sought to evaluate the efficacy of adding bevacizumab to cisplatin and etoposide in the first-line treatment of this population in a phase 3 trial.
For the study, investigators enrolled 204 treatment-naive patients with extensive-disease SCLC and randomly assigned them 1:1 to receive cisplatin plus etoposide with or without bevacizumab for up to 6 cycles. Patients receiving bevacizumab who did not experience disease progression continued bevacizumab alone until disease progression or for a maximum of 18 cycles.
At a median follow-up of 34.9 months, results showed that treatment with bevacizumab was associated with a significant improvement in progression-free survival compared with chemotherapy alone (P = .030); median progression-free survival was 6.7 months and 5.7 months, respectively.
However, researchers found no significant difference in the risk of death between the 2 treatment arms (hazard ratio [HR], 0.78; 95% CI, 0.58-1.06; P = .113). Median overall survival was 8.9 months with cisplatin plus etoposide vs 9.8 months with chemotherapy plus bevacizumab; 1-year survival rates were 25% and 37%, respectively.
Investigators observed a significant survival benefit in patients who received maintenance bevacizumab (HR, 0.60; 95% CI, 0.40-0.91; P = .011).
There were no statistically significant differences in the rates of hematologic toxicities between the arms, but hypertension was significantly more frequent in the bevacizumab arm (P = .057).
Although treatment with bevacizumab added no apparent survival advantage, the finding that adding immunotherapy improved progression-free survival suggests that further studies with novel and better antiangiogenic agents in extensive-disease SCLC are warranted.
1. Tiseo M, Boni L, Ambrosio F, 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. doi: 10.1200/JCO.2016.69.4844 [Epub ahead of print]