Abstract
BackgroundThe use of antiangiogenic therapy in non-small cell lung cancer (NSCLC) requires thorough evaluation of patient characteristics in order to avoid potential safety issues, particularly pulmonary haemorrhage (PH). The aim of this consensus by a panel of experts was to identify important criteria for the selection of patients with NSCLC who would benefit from antiangiogenic therapy.MethodsRadiologists and oncologists were selected for the expert panel. The nominal group technique (NGT) and the Delphi questionnaire were used for consensus generation. The NGT consisted of four steps, the result of which was used to set the Delphi questionnaire. A final report was generated based on the opinions of the experts from the panel.ResultsAn extremely important prerequisite for the evaluation of an antiangiogenic therapeutic approach in patients with NSCLC was thorough clinical and radiological analysis of the relationships between tumour and vascular or anatomical structures (performed in close co-operation by oncologists and radiologists). The panel identified major parameters to be considered before the use of antiangiogenic treatment, collectively agreeing on the relevance of tumour cavitation, vascular infiltration, endobronchial growth and thromboembolism for chest tumour sites, and of the presence of aneurysms, extra-thoracic bleeding, brain metastases or thrombi for extra-thoracic sites. Moreover, a structured report containing information not only on the tumour but also on the general vascular status is essential to guide the treatment choice The experts agreed that tumour localization in the absence of vessel infiltration, cavitation, and the use of antiplatelet therapy are relevant parameters to be assessed, but their presence should not necessarily exclude a patient from receiving antiangiogenic therapy.ConclusionClose co-operation between oncologists and radiologists in the diagnosis, treatment selection, and assessment of response is essential for ensuring therapeutic appropriateness in the NSCLC setting. It should be noted that neither the use of antiplatelet therapy nor tumour localisation are to be considered as contraindications to antiangiogenic treatment.
Highlights
The use of antiangiogenic therapy in non-small cell lung cancer (NSCLC) requires thorough evaluation of patient characteristics in order to avoid potential safety issues, pulmonary haemorrhage (PH)
Phase III studies have demonstrated the efficacy of the combination treatment with bevacizumab and carboplatin plus paclitaxel in NSCLC: the survival of the group assigned to bevacizumab plus chemotherapy was significantly improved compared with the group assigned to chemotherapy alone, both in a randomized trial by the Eastern Cooperative Oncology Group (ECOG) [6] and in the BEYOND trial (PFS: 9.2 versus 6.5 months, respectively; p 0.001) [7]
The AVAiL (Avastin in Lung) phase III study showed that cisplatin/gemcitabine plus bevacizumab (7.5 mg/kg or 15 mg/kg) offers clinical benefit as compared with cisplatin/gemcitabine plus placebo and is well tolerated in patients with advanced NSCLC [8, 9]
Summary
The use of antiangiogenic therapy in non-small cell lung cancer (NSCLC) requires thorough evaluation of patient characteristics in order to avoid potential safety issues, pulmonary haemorrhage (PH). The aim of this consensus by a panel of experts was to identify important criteria for the selection of patients with NSCLC who would benefit from antiangiogenic therapy. The AVAiL (Avastin in Lung) phase III study showed that cisplatin/gemcitabine plus bevacizumab (7.5 mg/kg or 15 mg/kg) offers clinical benefit as compared with cisplatin/gemcitabine plus placebo (median PFS: 6.7 versus 6.1 months, respectively, in the low-dose group, p = 0.003; 6.5 versus 6.1 months, respectively, in the high-dose group, p = 0.03) and is well tolerated in patients with advanced NSCLC [8, 9]. Bevacizumab is the only antiangiogenic agent currently approved for firstline NSCLC treatment and its use in combination with chemotherapy is recommended by international guidelines [12,13,14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
