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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As mentioned above, any clinical interaction with gemcitabine is likely to be small. Currently, ECOG is comparing maintenance bevacizumab with pemetrexed versus the combination and this study should establish the relative contributions of these two agents to improving survival [ 22 ].

A total of four trials were analyzed including two 5499 III studies and two randomized phase II trials. 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. Thus, the trial investigated the addition of bevacizumab to a sub-optimal doublet base for its target patient population.

Does bevacizumab selectively enhance paclitaxel-based regimens?

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

Should older patients be treated with bevacizumab? Close mobile search navigation Article navigation.

Of interest, Zhu et al. There was no difference in OS 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.


Of interest, only ecot with non-squamous cell histology were eligible. Association between VEGF splice isoforms and progression-free survival in metastatic colorectal cancer patients treated with bevacizumab.

Since then it has been established that gemcitabine is inferior to pemetrexed in non-squamous histology [ 1 ]. The optimal dose of bevacizumab also remains unclear, although the ECOG trial using the higher dose was the only trial to show significant improvement in survival. First, none of the tests for heterogeneity reached statistical significance and therefore, only the results of fixed effects models are provided.

Bevacizumab’s interaction with docetaxel Taxotere or nab-paclitaxel is not well established in lung cancer and will be of interest. A number of other anti-angiogenic agents have been investigated in advanced stage NSCLC without success.

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 scog offered the drug i.

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

The role of bevacizumab in the maintenance setting remains unclear. The overall marginally positive statistical survival data reported by the authors are most likely explained by the fact that the large paclitaxel-based trial ECOG is not fundamentally disturbed by the less positive gemcitabine trial AVAiLwhile the two smaller paclitaxel-based studies contribute only marginally to the overall results. Palliative chemotherapy improves the quality of life and prolongs survival in patients with metastatic non-small-cell lung cancer NSCLC.

It has also been investigated in multiple other solid tumors and is part of standard therapy in colorectal cancer, gliomas and renal cell cancer. 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. Comment in N Engl J Med. Synergy of nab-paclitaxel and bevacizumab in eradicating large orthotopic breast tumors and preexisting metastases.


Patients on both study arms continued with maintenance therapy either bevacizumab alone or bevacizumab and pemetrexed. Recently, two additional randomized trials have provided us with new data on bevacizumab. In this edition of Annals of OncologySoria et al. Is the conclusion that bevacizumab added to any platinum-based chemotherapy prolongs survival supported by these data?

In mouse modeling of 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 ].

However, a search for reliable, predictive biomarkers allowing for patient selection continues [ 7 ].

However, this was not a randomized comparison and therefore, is subject to bias. Vandetanib plus docetaxel versus docetaxel as second-line treatment for patients with advanced non-small-cell lung cancer ZODIAC: This strategy has been only marginally successful. Outcomes for elderly, advanced-stage non-small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: The principles of anti-angiogenic therapy have been of laboratory and clinical interest for many years [ 6 ].

The addition of bevacizumab to pemetrexed remains of some interest.