Is combined treatment with erlotinib and bevacizumab effective in non-small cell lung cancer?

This study investigated the effectiveness of erlotinib (Tarceva) and bevacizumab (Avastin) compared ti erlotinib alone in non-small cell lung cancer (NSCLC). They found that combined treatment improved survival after 12 months.

Non-small cell lung cancer (NSCLC) is a common type of lung cancer (LC). Standard treatment may involve chemotherapy or radiation. Many patients are diagnosed with LC at an advanced stage. Newly developed drugs are designed to target gene mutations that allow tumors to grow rapidly. One target is the epidermal growth factor receptor (EGFR) gene. EGFR mutations are common in NSCLC. Erlotinib is a drug that blocks an enzyme (tyrosine kinase, TK) that allows EGFR to function.

Erlotinib is effective in NSCLC. However, evidence suggests that patients become resistant to the effect of erlotinib after 1 year. Combining it with other drugs may improve NSCLC prognosis. Bevacizumab is a drug that targets vascular endothelial growth factor (VEGF). This reduces blood supply to tumors and slows growth. It is unclear if combining erlotinib and bevacizumab is effective in advanced NSCLC.

This study included 224 patients with stage 3 or 4 NSCLC. Patients were randomly assigned to receive either erlotinib alone (150 mg daily) or erlotinib and bevacizumab (15 mg/kg, once every 3 weeks). Blood samples were taken every 3 weeks. Tumor progression was measured every 6 weeks over 18 months. It was assessed every 12 weeks after this. Treatment continued until disease progression or side effects were unacceptable. 

Survival without cancer progression was improved in patients in the combination group compared to erlotinib alone (16.9 months vs. 13.3 months). 88% of the combination group reported severe to life-threatening side effects. 46% of the erlotinib alone group reported severe to life-threatening side effects. The most common was rash in 21% in each group.

The authors concluded that erlotinib and bevacizumab improved survival in patients with NSCLC after 12 months of treatment. 

The number of patients in this study was small. This trial is ongoing. More results will be reported and a full analysis will be performed at that stage.