Addition of bevacizumab to pemetrexed plus cisplatin may significantly improve overall survival in patients with malignant pleural mesothelioma, according to a study published in The Lancet.

However, patients are at higher risk of manageable toxic effects.

Researchers led by Gérard Zalcman, MD, PhD, of the University of Caen in France conducted a randomized, controlled, open-label, phase 3 trial of 448 patients with unresectable malignant pleural mesothelioma who had received previous chemotherapy and had an Eastern Cooperative Oncology Group performance status of 0 to 2.

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From February 2008 to January 2014, patients received either pemetrexed plus cisplatin with or without bevacizumab in 21-day cycles for up to 6 cycles. Primary outcome was overall survival in the intention-to-treat population.

The researchers found that overall survival was significantly longer with the addition of bevacizumab at a median of 19.8 months compared with 16.1 months without bevacizumab.

In addition, 158 of the 222 patients (71%) who received bevacizumab had grade 3 to 4 adverse events compared to 139 of 224 patients (62%) who had not received bevacizumab. There were more grade 3 or higher hypertension and thrombotic events in the group that received bevacizumab.

The authors concluded that addition of bevacizumab to pemetrexed and cisplatin “should be considered as a suitable treatment for the disease.”


  1. Zalcman G, Mazieres J, Margery J, et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial [published online ahead of print December 21, 2015]. The Lancet. doi: