HHS Public Access Author manuscript Author Manuscript
Cancer. Author manuscript; available in PMC 2016 May 02. Published in final edited form as: Cancer. 2016 April 1; 122(7): 1047–1049. doi:10.1002/cncr.29894.
Bevacizumab beyond disease progression for advanced NSCLC: Does persistence have its rewards? Irene Guijarro-Munoz, PhD1, Emily B. Roarty, PhD1, and John V. Heymach, MD, PhD1,2 1Department
of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, 77030.
Author Manuscript
2Department
of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston
TX, 77030.
Author Manuscript
In selecting cancer treatments, as in life, sometimes it pays to be persistent. But not knowing when to quit carries its own hazards as well, particularly in the face of potentially diminishing benefits, increasing toxicities, and significant costs. These issues become even more relevant as new treatment options emerge with more favourable toxicity profiles, enabling long term treatment without the cumulative toxicities of chemotherapy. Whether or not there is benefit to continuing a targeted drug past progression depends on a host of factors, and likely varies by drug and tumor type. For example, does the tumor retain at least some dependence on a target blocked by the drug, or does the resistance mechanism completely bypass the target? Does stopping the drug induce a “rebound” effect that could accelerate tumor progression when the drug is stopped?
Author Manuscript
For VEGF inhibitors such as bevacizumab, preclinical and clinical studies in other tumor types suggest that there may be benefit to continuing treatment beyond progression but it was previously unknown whether non-small cell lung cancer (NSCLC) patients would benefit from such an approach. In this issue of Cancer, Takeda and colleagues have addressed this issue. They have conducted a randomized phase II study with 100 patients with non-squamous NSCLC who have progressed after first-line platinum-based chemotherapy with bevacizumab. Patients were randomized to either docetaxel alone or docetaxel with bevacizumab, with a primary endpoint of progression-free survival (PFS). The bevacizumab arm demonstrated modestly prolonged PFS at 4.4 months compared with 3.4 months in the control arm (HR = 0.71, p = 0.058), which achieved the pre-defined statistical endpoint with a one-sided p value of
Cancer. Author manuscript; available in PMC 2016 May 02. Published in final edited form as: Cancer. 2016 April 1; 122(7): 1047–1049. doi:10.1002/cncr.29894.
Bevacizumab beyond disease progression for advanced NSCLC: Does persistence have its rewards? Irene Guijarro-Munoz, PhD1, Emily B. Roarty, PhD1, and John V. Heymach, MD, PhD1,2 1Department
of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston TX, 77030.
Author Manuscript
2Department
of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston
TX, 77030.
Author Manuscript
In selecting cancer treatments, as in life, sometimes it pays to be persistent. But not knowing when to quit carries its own hazards as well, particularly in the face of potentially diminishing benefits, increasing toxicities, and significant costs. These issues become even more relevant as new treatment options emerge with more favourable toxicity profiles, enabling long term treatment without the cumulative toxicities of chemotherapy. Whether or not there is benefit to continuing a targeted drug past progression depends on a host of factors, and likely varies by drug and tumor type. For example, does the tumor retain at least some dependence on a target blocked by the drug, or does the resistance mechanism completely bypass the target? Does stopping the drug induce a “rebound” effect that could accelerate tumor progression when the drug is stopped?
Author Manuscript
For VEGF inhibitors such as bevacizumab, preclinical and clinical studies in other tumor types suggest that there may be benefit to continuing treatment beyond progression but it was previously unknown whether non-small cell lung cancer (NSCLC) patients would benefit from such an approach. In this issue of Cancer, Takeda and colleagues have addressed this issue. They have conducted a randomized phase II study with 100 patients with non-squamous NSCLC who have progressed after first-line platinum-based chemotherapy with bevacizumab. Patients were randomized to either docetaxel alone or docetaxel with bevacizumab, with a primary endpoint of progression-free survival (PFS). The bevacizumab arm demonstrated modestly prolonged PFS at 4.4 months compared with 3.4 months in the control arm (HR = 0.71, p = 0.058), which achieved the pre-defined statistical endpoint with a one-sided p value of
