Is the Survival Benefit with Avastin Added to Chemotherapy Enough to Change the Standard of Care in Mesothelioma?

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Drs. Ben Solomon, Leora Horn, & Jack West discuss highlights of a French randomized trial that demonstrated a significant survival benefit from addition of Avastin (bevacizumab) to cisplatin/Alimta in patients with malignant pleural mesothelioma.


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Dr. West:  So, one of the other topics that’s covered in this broad thoracic malignancies conference is mesothelioma, where one of the biggest bits of news that we got this year actually came at ASCO, earlier this year, in a French trial that showed that adding Avastin (bevacizumab) to standard chemotherapy, in this case, cisplatin and Alimta (pemetrexed), seemed to improve survival in a clinically significant way. What do you think of these data — is this changing practice for you or around you, Ben?

Dr. Solomon:  Sure, look, I think it’s an important study — the initial study that showed benefit of cisplatin and pemetrexed, over cisplatin alone, was the first phase three study that showed a survival benefit in mesothelioma. This is the second study, and I think the benefits are meaningful. There was an improvement in progression-free survival of about two months — the improvement in overall survival was a bit more than that. So, I do think that that difference is meaningful, and I think it’s likely that bevacizumab, in that context, will get incorporated into standard practice.

Dr. West:  What do you say?

Dr. Horn:  I think that is possible — what I worry is that pemetrexed and bevacizumab together is a more toxic combination, and it is not as easy and as tolerable as pemetrexed alone, but for those patients who can tolerate it, it is a good, new treatment option for them.

Dr. West:  So it’s not something you’re uniformly inclined to incorporate for most or all of your patients with mesothelioma?

Dr. Horn:  It’s such a rare disease, so not right now. What I also worry about is a lot of the mesothelioma patients are older, and, so, that same worry about tolerability.


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