ASCO 2019: Comparing Maintenance Therapies for Nonsquamous Lung Cancer
Posted: Friday, June 14, 2019
Combining bevacizumab and pemetrexed seems to offer no overall survival benefit over treatment with either agent individually in maintenance therapy for patients with advanced nonsquamous non–small cell lung cancer, results of a phase III trial indicate. These outcomes of ECOG-ACRIN 5508 were presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago (Abstract 9002).
Suresh S. Ramalingam, MD, of Emory University’s Winship Cancer Institute in Atlanta, and colleagues noted that pemetrexed and bevacizumab are each evidence-based options. However, some documentation existed for the combination therapy being able to improve progression-free survival in this setting. Their study’s primary endpoint was overall survival.
The study initially included 1,516 patients who had no prior systemic therapy and an Eastern Cooperative Oncology Group performance status of 0 or 1. All began treatment with induction therapy consisting of carboplatin, paclitaxel, and bevacizumab, every 3 weeks for up to 4 cycles. Then, of these patients, 874 with stable disease, partial response, or complete response were randomly assigned 1:1:1 to receive bevacizumab, pemetrexed, or bevacizumab plus pemetrexed every 3 weeks until disease progression.
With a median follow-up in maintenance therapy of 50.6 months, the differences in overall survival among the groups were not statistically significant: 14.4 months, 15.9 months, and 16.4 months in the bevacizumab, pemetrexed, and combination arms, respectively. Grade 3, 4, and 5 toxicities tended to be worse in the combination group, with hypertension, neutropenia, and fatigue being the most common.
Despite the benefits it offers in terms of progression-free survival, “the combination of bevacizumab and pemetrexed cannot be recommended due to the lack of [overall] survival benefit in this definitive study,” wrote Dr. Ramalingam and his team.
Disclosure: The study authors’ disclosure information may be found at coi.asco.org.
