to paclitaxel/carboplatin, prolongs survival in previously untreated patients with advanced non-small-cell lung cancer: preliminary results from the ECOG Lung Cancer: Secondary Analyses of the ECOG and PointBreak Trials. Eastern Cooperative Oncology Group (E) and PointBreak studies. ECOG demonstrated longer progression-free (PFS) and overall survival ( OS) with the addition of bevacizumab at a dose of 15 mg/m2.

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Treating patients with EGFR sensitizing mutations: Sign In or Create an Account. The role of bevacizumab in the maintenance setting remains unclear.

Molecular biomarkers in non-small-cell lung cancer: It has also been investigated in multiple other solid tumors and is part of standard therapy in colorectal cancer, gliomas and renal cell cancer.

In fact, the median survival of Disclosure — in the Blink of an Eye. In summary, the meta-analysis provided here may not allow us to truly improve our assessment of the role of bevacizumab in combination with chemotherapy for advanced-stage NSCLC.

Nevertheless, it suggests that the addition of bevacizumab to paclitaxel-based doublet chemotherapy since its approval in the United States has not led to improved survival data in this Medicare population.

Analyzed separately, these trials support the administration of bevacizumab with carboplatin and paclitaxel, while its administration with gemcitabine underperforms for the survival end point and is not clinically relevant since gemcitabine is preferentially given to patients with squamous cell histology who are poor candidates for bevacizumab due to risk of pulmonary hemorrhage.

Does bevacizumab selectively enhance paclitaxel-based regimens? Its precise contribution to increasing survival remains unclear. Outcomes for elderly, advanced-stage non-small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: The median progression-free survival in the two groups was 6.

In mouse modeling 459 breast and lung cancers, a paclitaxel and bevacizumab combination is synergistic, potentially due to increased paclitaxel concentrations in the tumor secondary to the downregulation of vascular permeability [ 18 ].


Our recommendation at this point is to consider as evidence-based the use of bevacizumab with carboplatin and paclitaxel as established in EGOG Between July and Aprilthe Eastern Cooperative Oncology Group ECOG conducted a randomized ceog in which patients with recurrent or advanced non-small-cell lung cancer stage IIIB or IV were assigned to chemotherapy with paclitaxel and carboplatin alone or paclitaxel and carboplatin plus bevacizumab Rapid chemotherapy-induced actue endothelial progenitor cell mobilization: Maintenance pemetrexed significantly increased PFS and in early reporting showed a positive trend for survival.

In luciferase-tagged breast cancer mouse models with metastases to lungs, metastasis formation was decreased with nab-paclitaxel and bevacizumab when compared with each drug alone [ 21 ]. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carboplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer.

Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer.

Should older patients be treated with bevacizumab? Prognostic significance of angiogenesis and angiogenic growth factors in nonsmall cell lung cancer. As mentioned above, any clinical interaction with gemcitabine is likely to be small.

Three of the trials used a paclitaxel Taxol -based regimen and one used gemcitabine.

This meta-analysis seems to suggest possible increased benefits in patients with stage IIIB disease, although it is not clear whether this included patients with stage IIIB disease due to advanced nodal stage or due to pleural effusion.

The median survival was The addition of bevacizumab to pemetrexed remains of some interest. Finally, two of the studies included high-dose and low-dose bevacizumab.

Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer.

However, a majority of patients do not have this option and continue to be offered standard doublet chemotherapy. The broad conclusion that bevacizumab can be added to doublet chemotherapy with a survival benefit seems exaggerated, given that only two specific doublets were examined, one in patients who would no longer be offered the drug i.


There was no difference in OS ECOG will continue to dominate current ecot recommendations and the only evidence-based regimen to which bevacizumab should reasonably be added as a standard remains carboplatin and paclitaxel. Rates of clinically significant bleeding were 4. Erratum in N Engl J Med. The meta-analysis was, therefore, based on the reported summary data, both overall and within subgroups. A number of other anti-angiogenic agents have been investigated in advanced stage NSCLC without success.

Finally, predictive markers are needed. The addition of bevacizumab to paclitaxel plus carboplatin in the treatment of selected patients with non-small-cell lung exog has a significant survival benefit with the risk of increased treatment-related deaths.

Of greater clinical interest has been the interaction of pemetrexed with bevacizumab.

Given the associated cost and toxicity however, optimizing the patient-population exposed to these agents remains a high priority. In the phase III AVAiL trial, patients were treated with cisplatin and gemcitabine versus the triplet regimen with bevacizumab administered at either 7.

In this meta-analysis, diminished activity of bevacizumab in older patients was not seen, while the single-trial sub-analysis of ECOG suggested no benefit for older patients. A total of four trials were analyzed including two phase III studies and two randomized phase II trials.

Recent modifications have been the introduction of histology as a parameter defining the optimal choice of a doublet regimen and the emergence of single-agent maintenance chemotherapy for patients without progression on initial doublet therapy [ 12 ].

This strategy has been only marginally successful. Both bevacizumab and pemetrexed can be administered as maintenance and it will be crucial to determine if both the drugs together truly outperform the individual drugs in that setting.

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