Drs. Ben Solomon, Leora Horn, & Jack West review trial result and implications of ECOG 1505 trial that showed no benefit to addition of Avastin (bevacizumab) to adjuvant chemotherapy for early stage NSCLC.
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Dr. West: So, we just finished the presidential symposium at the World Conference on Lung Cancer, here in Denver. There were a few high-profile presentations there, including one that was anxiously anticipated, that was presented by Heather Wakelee, a colleague of ours, who presented the ECOG 1505 trial of chemotherapy with or without Avastin (bevacizumab), the anti-angiogenic agent, as post-operative therapy for patients with a resected lung cancer. Unfortunately, a totally negative trial, I’d say. Do you think there was anything to be gleaned from that, or do you think it even might have some negative effects on its use outside of that setting, like metastatic disease, Leora?
Dr. Horn: So, I don’t think I was surprised by the results, I think I was disappointed, but I don’t think it’s going to really change how Avastin is used outside of — in metastatic disease, outside of the adjuvant setting. I think there’ll be some interesting subset analysis to come out — so things like, is there a difference between the different chemotherapy regimens that were used? Because, I know, in places like the U.S., we extrapolate the metastatic data to the adjuvant setting, and some of the biomarker data.
Dr. West: Ben, what did you think?
Dr. Solomon: Yeah, I’d agree completely with Leora, I mean, it was a big study, 1,500 patients enrolled, and I think it gives us a definitive answer about bevacizumab in the adjuvant setting — there was no difference in outcomes whether you had bevacizumab or not. But it is a different situation to the metastatic setting, these patients had no residual disease, and even pre-clinically, we know that the efficacy of bevacizumab may be different in primaries versus metastases. So, I think, in this situation, we maybe need to take a little bit of care from extrapolating from the adjuvant to the metastatic setting.
Dr. West: What’s the pattern in Australia, in terms of how widely used bevacizumab, or Avastin, is in metastatic disease? I would say it’s certainly used as a standard of care in the U.S., and I think in various parts of the world, but it’s not something that is, certainly, uniformly used in every possibly eligible patient.
Dr. Solomon: Yes — so, in Australia, I think our sort of usage pattern is a bit closer to the European usage — so, bevacizumab is very rarely used, and partly this reflects the fact that it’s not reimbursed. And I think we’re influenced by the AVAiL data, which didn’t show an improvement in survival, in contrast to the ECOG study which did. So, bevacizumab can only be used in the setting where patients pay for it, and as a consequence, isn’t really a part of common practice.