EGFR+ NSCLC: no benefit for bevacizumab with frontline erlotinib

  • Stinchcombe TE & al.
  • JAMA Oncol
  • 8 Aug 2019

  • curated by Craig Hicks
  • Univadis Clinical Summaries
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Takeaway

  • Adding bevacizumab to standard frontline erlotinib failed to extend progression-free survival (PFS) in a phase 2 trial of patients with epidermal growth factor receptor mutation-positive (EGFR+) NSCLC.

Why this matters

  • Previous trials had suggested benefit for combination therapy.

Study design

  • Multicenter phase 2 clinical trial of 88 patients (median age, 63 [range, 31-84] years; 70% women) with stage IV EGFR+ NSCLC randomly assigned to receive erlotinib with or without bevacizumab, continued until disease progression, unacceptable adverse event, or withdrawal of consent.
  • 85% were white, and 55% were never-smokers.
  • Median follow-up was 33 (range, 0.7-62.5) months.
  • Funding: Genentech/Roche.

Key results

  • Combination therapy vs erlotinib alone showed no significant benefit in terms of:
    • PFS: median, 17.9 vs 13.5 months (HR, 0.81; P=.39).
    • Objective response rate: 81% vs 83% (P=.81).
    • OS: median, 32.4 vs 50.6 months (HR, 1.41; P=.33).
  • Grade ≥3 adverse events reported more commonly with combination therapy included skin eruptions (26% vs 16%), hypertension (40% vs 20%), and proteinuria (12% vs 0%).

Limitations

  • Small sample size with few events.
  • Few circulating free DNA blood samples collected.