- Combining pemetrexed and bevacizumab maintenance therapy increased toxicity with no survival benefit over either drug alone in patients with advanced nonsquamous NSCLC.
- Single-agent maintenance therapy was optimal in this randomized trial.
Why this matters
- National guidelines recommend pemetrexed, bevacizumab, or their combination as maintenance therapy, the latter based on previous research suggesting PFS benefit.
- Multicenter phase 3 ECOG-ACRIN 5508 trial.
- 874 patients with advanced nonsquamous NSCLC and no progression after first-line combination chemotherapy were randomly assigned to maintenance pemetrexed (n=294), bevacizumab (n=287), or both (n=293).
- Median follow-up, 50.6 months.
- Funding: National Cancer Institute.
- No significant difference in median OS between pemetrexed and bevacizumab (15.9 vs 14.4 months; P=.12) or combination therapy vs bevacizumab (16.4 vs 14.14 months; P=.28).
- No significant difference in median PFS between pemetrexed and bevacizumab (5.1 vs 4.2 months; P=.06) or, after multivariate analysis, between combination therapy and bevacizumab (7.5 vs 4.2 months; P=.22).
- The combination group had greater grade 3-5 toxicity rates vs bevacizumab and pemetrexed (51% vs 30% vs 38%).
- None included.