Multicenter phase II study on cisplatin, pemetrexed, and bevacizumab followed by maintenance with pemetrexed and bevacizumab for patients with advanced or recurrent nonsquamous non-small cell lung cancer: MAP study.

Abstract

BACKGROUND:

We evaluated the safety and efficacy of induction chemotherapy with bevacizumab followed by maintenance chemotherapy with bevacizumab for advanced non-small cell lung cancer (NSCLC) in this multicenter phase II study.

METHODS:

Chemotherapy-naïve patient with stage IIIB-IV or recurrent nonsquamous NSCLC were eligible. We planned approximately four cycles of induction cisplatin (75 mg/m2), pemetrexed (500 mg/m2), and bevacizumab (15 mg/kg) followed by maintenance with pemetrexed (500 mg/m2) and bevacizumab (15 mg/kg) until disease progression. Progression-free survival (PFS) was the primary endpoint.

RESULTS:

Forty patients received a median of four induction chemotherapy cycles. Of them, 35 (87.5%) patients received a median of nine maintenance chemotherapy cycles. The objective response was 70.6%, and the disease control rate was 97.1%. The median PFS was 10.8 (95% CI, 9.0-12.6), and overall survival was 48.0 (95% CI, 32.9-63.1) months. Median PFS of 23 patients with epidermal growth factor receptor (EGFR) mutations and of 16 patients without EGFR mutations were 12.9 (95% CI, 9.4-16.3) and 7.9 (95% CI, 1.1-14.7) months, respectively. Toxicities graded ≥3 included neutropenia (15%), anemia (15%), hypertension (7.5%), anorexia (7.5%), fatigue (7.5%), thromboembolic events (5%), jaw osteonecrosis (5%), nausea (2.5%), oral mucositis (2.5%), tumor pain (2.5%), hyponatremia (2.5%), and gastrointestinal perforation (2.5%). Treatment-related deaths were not found.

CONCLUSIONS:

In patients with advanced or recurrent nonsquamous NSCLC, induction chemotherapy with cisplatin, pemetrexed, and bevacizumab followed by maintenance chemotherapy with pemetrexed and bevacizumab is safe and effective regardless of their EGFR mutation status.

TRIAL REGISTRATION:

UMIN Clinical Trial Registry: UMIN000005569 . Registered date: May 8, 2011.

• Authors: Yasuhiro Tsutani, Yoshihiro Miyata, Takeshi Masuda, Kazunori Fujitaka, Mihoko Doi, Yoshikazu Awaya, Shoichi Kuyama, Soichi Kitaguchi, Kazuhiro Ueda, Noboru Hattori, Morihito Okada
• Journal: BMC cancer (BMC Cancer) Vol. 18 Issue 1 Pg. 1231 (Dec 10 2018) ISSN: 1471-2407 [Electronic] England
• PMID: 30526545 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study)

Chemical References

• Pemetrexed
• Bevacizumab
• Cisplatin

Topics

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Bevacizumab (administration & dosage)
• Carcinoma, Non-Small-Cell Lung (drug therapy, mortality)
• Cisplatin (administration & dosage)
• Female
• Humans
• Induction Chemotherapy (methods)
• Kaplan-Meier Estimate
• Lung Neoplasms (drug therapy, mortality)
• Maintenance Chemotherapy (methods)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy)
• Pemetrexed (administration & dosage)
• Progression-Free Survival
• Treatment Outcome