The Pharmaceutical Journal
Vol 277 No 7432 p762
23/30 December 2006

This article
Reprint   Photocopy

  Acrobat Reader

News summary

Bevacizumab plus chemotherapy improves survival in lung cancer

Addition of bevacizumab to a standard platinum-based, two-agent chemotherapy regimen in the treatment of selected patients with non-small-cell lung cancer improves survival but is associated with an increased risk of treatment-related deaths, according to research published in The New England Journal of Medicine last week (2006;355:2542).

Researchers randomised 878 patients with recurrent or advanced non-small-cell lung cancer to receive chemotherapy with paclitaxel and carboplatin or paclitaxel and carboplatin plus bevacizumab. The chemotherapy was administered every three weeks for six cycles. Bevacizumab was administered every three weeks until disease progression or until toxic effects were intolerable. Patients with squamous-cell tumours, brain metastases, clinically significant haemoptysis or inadequate organ function were excluded.

The median survival was 12.3 months in the bevacizumab group compared with 10.3 months in the chemotherapy-alone group (hazard ratio 0.79, 95 per cent confidence interval 0.67–0.92; P=0.003).

Median progression-free survival was also improved in the bevacizumab group compared with the chemotherapy-alone group (6.2 months vs 4.5 months, HR 0.66, CI 0.57–0.77; P<0.001). Response rates were 35 per cent and 15 per cent, respectively (P<0.001).

Rates of adverse events, including hypertension, proteinuria, bleeding, neutropenia, febrile neutropenia, thrombocytopenia, hyponatraemia, rash and headache were higher in the bevacizumab group (P<0.05). The difference between the two groups appeared during the third cycle. In addition, there were 15 deaths related to toxic effects of treatment in the bevacizumab group and two in the chemotherapy-alone group (P=0.001). Most of the deaths occurred during the first two cycles of therapy.

The researchers explain that bevacizumab works well in combination with chemotherapy because, in addition to cutting off the tumour’s blood supply, it makes the remaining blood vessels healthier and enables them to diffuse the chemotherapy drugs into the tumour better.

They say that the increased risk of toxic effects must be considered within the context of the survival benefit conferred.