Bevacizumab in EGFR-positive NSCLC: time to change first-line treatment?

Abstract

The first-line treatment for patients with advanced non-small-cell lung cancer (NSCLC) with a common EGFR mutation is EGFR tyrosine kinase inhibitor (TKI) monotherapy. Once patients have disease progression and continuing treatment is deemed inappropriate, patients with EGFR Thr790Met resistance mutations are switched to osimertinib, 1 Yang JC Ahn MJ Kim DW et al. Osimertinib in pre-treated T790M positive advanced NSCLC: AURA study phase II extension cohort. J Clin Oncol. 2017; 35: 1288-1296 Google Scholar or to pemetrexed and cisplatin if osimertinib was the first-line treatment. Subsequent treatment after disease progression following second-line treatment is more complicated and should be personalised according to clinical manifestations and genomic tumour alterations. Recent clinical trials have shown that median overall survival for patients with EGFR-positive NSCLC ranges between 3 and 5 years. 2 Hsu WH Yang JC Mok TS Loong HH Overview of current systemic management of EGFR-mutant NSCLC. Ann Oncol. 2018; 29: i3-i9 Google Scholar Erlotinib plus bevacizumab versus erlotinib alone in patients with EGFR-positive advanced non-squamous non-small-cell lung cancer (NEJ026): interim analysis of an open-label, randomised, multicentre, phase 3 trialThe results of this interim analysis showed that bevacizumab plus erlotinib combination therapy improves progression-free survival compared with erlotinib alone in patients with EGFR-positive NSCLC. Future studies with longer follow-up, and overall survival and quality-of-life data will be required to further assess the efficacy of this combination in this setting. Full-Text PDF