Non-small cell lung cancer (NSCLC) accounts for approximately 80% of all cases of lung cancer, and >60% of patients with NSCLC present with locally advanced or metastatic (stage III/IV) disease at initial diagnosis.
Historically, first-line treatment for patients with advanced NSCLC has been platinum-based doublet chemotherapy, in combination with a third-generation cytotoxic compound such as gemcitabine or docetaxel. However, response to first-line chemotherapy is generally short lived, with progression occurring, on average, 4–6 months after treatment is discontinued and a median survival duration of only 8–11 months.
Recently, the combination of erlotinib and bevacizumab has displayed very encouraging activity in a randomized phase II trial in patients with previously treated NSCLC. In one recently reported trial, called Atlas, patients were initially treated with Avastin plus chemotherapy followed by the addition of Tarceva to Avastin in the maintenance phase. Genentech said the trial was stopped early (Feb. 2009) after an interim analysis found that combining Avastin, known generically as bevacizumab, and Tarceva, or erlotinib, significantly extended the time patients with non-small cell lung cancer lived without their disease advancing.
Combination of bevacizumab and Tarceva is being investigated, for example in SO635 trial and in others as well. One such trial is NSCLC (Non-Small Cell Lung Cancer), NCT00095225, A Study to Evaluate Bevacizumab and Chemotherapy or Tarceva in Treating Recurrent or Refractory NSCLC (Non-Small Cell Lung Cancer).
Rabiya S. Tuma Success of Bevacizumab Trials Raises Questions for Future Studies
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Herbst RS, Fehrenbacher L, Belani CP et al. Phase II study of efficacy and safety of bevacizumab in combination with chemotherapy or erlotinib compared with chemotherapy alone for treatment of recurrent or refractory non small-cell lung cancer. J Clin Oncol 2007;25:4743–4750
Herbst, Roy S. , Sandler, Alan
Bevacizumab and Erlotinib: A Promising New Approach to the Treatment of Advanced NSCLC
Oncologist 2008 13: 1166-1176;