Bevacizumab Plus Erlotinib May Be a New Standard of Care in Non-Small Cell Lung Cancer

CHICAGO—Bevacizumab plus erlotinib may be a new standard therapy among treatment-naive patients with epidermal growth factor receptor (EGFR)-mutation positive non-small cell lung cancer (NSCLC), according to data presented at the 2018 American Society of Clinical Oncology Annual Meeting on Monday, June 4.¹

Monotherapy with EGFR-tyrosine kinase inhibitors (TKIs), such as afatinib, erlotinib, and gefitinib, have been explored as therapeutic options among patients with EGFR-positive NSCLC. Recent studies have explored the potential of combination therapy with EGFR-TKIs and VEGF-inhibitors for this patient population.

In the phase 3 NEJ026 study, investigators randomly assigned 228 chemotherapy-naive patients to receive oral erlotinib 150 mg daily alone or with bevacizumab 15 mg/kg every 3 weeks. Patients’ EGFR-mutation statuses were monitored throughout the course of the study and a second-line therapy. The median follow-up time was 12.4 months.

At the time of data cut-off, the median progression-free survival (PFS) by independent review was 16.9 months (95% CI, 14.2-21.0) among patients in the combination arm compared with 13.3 months among patients treated with erlotinib alone (hazard ratio [HR], 0.605; 95% CI, 0.417-0.877; P = .0157). PFS by investigator assessment was 16.6 vs 12.4 months among patients in the bevacizumab arm and erlotinib monotherapy arm, respectively [HR, 0.563; 95% CI, 0.394-0.804; P = .00057).

Further subgroup analysis based on EGFR-mutation status showed that patients with exon19 deletion had a median PFS of 16.6 months when treated with bevacizumab plus erlotinib compared with 12.4 months among patients who received erlotinib alone (HR, 0.69; 95% CI, 0.41-1.16). Patients with exon21 L858R mutations had a median PFS of 17.4 months and 13.7 months when treated with combination or monotherapy, respectively (HR, 0.57; 95% CI, 0.33-0.97).

Patients treated with bevacizumab and erlotinib had significantly higher rates of hemorrhage, proteinuria, and hypertension compared with erlotinib alone, but there were no other significant differences in toxicity profiles between the study arms. Five patients developed low-grade pneumonitis in the erlotinib arm, but no cases were reported in the bevacizumab arm.

The authors concluded that “[bevacizumab plus erlotinib] demonstrated a significant prolongation of PFS and [was well tolerated]. This regimen is considered [the] new standard treatment in patients with EGFR-mutated NSCLC.”

Read more of Cancer Therapy Advisor‘s coverage of the American Society of Clinical Oncology (ASCO) 2018 meeting by visiting the conference page.

Reference

1. Furuya N, Fukuhara T, Saito H, et al. Phase III study comparing bevacizumab plus erlotinib to erlotinib in patients with untreated NSCLC harboring activating EGFR mutations: NEJ026. Oral presentation at: 2018 ASCO Annual Meeting; June 1-5, 2018; Chicago, IL.