Erlotinib Plus Bevacizumab as First-Line Treatment for EGFR+, Advanced NSCLC

Conference Correspondent - ASCO 2014 - Lung Cancer

Despite advances in therapy of NSCLC represented by EGFR-TKIs, median progression-free survival (PFS) in patients with EGFR-mutation positive (mut) NSCLC is still only about 13 months. There is some evidence from prior studies that using erlotinib (E) plus bevacizumab (EB) may prolong disease-free survival in these patients. Thus, an open-label randomized trial was undertaken in 154 patients with EGFR-mut stage IIIB/IV or recurrent nonsquamous NSCLC in which they were randomized to receive EB or E until disease progression or unacceptable toxicity (Kato T, et al. ASCO 2014. Abstract 8005). The primary end point for the study was PFS, with secondary end points of overall survival, objective response rate (ORR), safety, and quality of life. The median PFS was 16.0 months for the EB group and 9.7 months for the E group (P = .0015). Median PFS in patients with EGFR exon 19 deletion was 18.0 months with EB and 10.3 months with E. The ORR to EB and E was 69% and 64%, respectively. Adverse events were generally manageable, with grade 3/4 rash or bleeding observed more frequently with EB, but with no difference among the groups in the incidence of interstitial lung disease. This study showed that EB extends PFS in these patients compared with E; in keeping with the theme at ASCO 2014 of “Science and Society,” oncologists must now face the question as to whether the extension of median PFS by approximately 6 months justifies the additional cost of using bevacizumab in these patients.