Home » Lung cancer: combo of two drugs delays progression by 6 months, especially in smokers

Lung cancer: combo of two drugs delays progression by 6 months, especially in smokers

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Six months of respite. They are the ones who manage to give the combination of two drugs, bevacizumab and erlotinib, to patients with lung cancer who have a gene mutation (EGFR). A result possible thanks to the double action obtained by combining bevacizumab, an antiangiogenic drug that hinders the ability of the tumor to create its own blood vessels, with erlotinib, one of the first ‘smart’ molecules approved for this pathology in recent years. The data emerges from Beverly, a phase 3 randomized multicentre clinical trial, promoted and coordinated by the National Cancer Institute Pascale Foundation of Naples and presented at the Congress of the European Society of Medical Oncology (Eemo), which closes today.

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Fifteen months without progression of the disease

This new study was carried out on the spur of the promising results reported in a Japanese trial published in 2014 and with the aim of confirming these data in Western countries. “Adding bevacizumab to erlotinib therapy – he explains Francesco Perrone, member of the national board of Aiom (Italian Association of Medical Oncology) and director of the Complex Clinical Trials of the ‘Pascale’ of Naples – delayed the progression of the disease by about 6 months compared to patients treated with erlotinib alone. One hundred and sixty patients were treated with erlotinib alone or with the combination of erlotinib plus bevacizumab in 43 centers in our country and then compared. Time without disease progression was significantly longer for the combination group, with a median duration of 15 versus 9 months. And the percentage of patients with tumor size reduction increased from 50% to 70% with the combination. “

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The impact on the quality of life

These results were also confirmed when radiological tests evaluating the disease were independently examined by radiologists unaware of the treatment practiced. Overall survival was also longer (33 versus 22 months at the median) for patients who received the combination, but this is currently not statistically significant. “The greater effectiveness of the combination was associated with a slightly worse toxicity profile, but completely in line with expectations – he says. Marilina Piccirillo, director of the ‘Pascale’ Clinical Trials Unit, which presented the Beverly study to ESMO. “There was a higher frequency of events such as increased blood pressure, mild kidney problems (typical side effects of bevacizumab) and skin erythema (due to erlotinib being administered for a longer time in patients treated with the combination ). The quality of life was not different between the two groups in comparison. We believe these data are important, because ‘Beverly’ represents the most compelling evidence on the efficacy of the combination in a Western patient population. Furthermore, the subgroup analyzes generate the hypothesis that the benefit may be relevant especially for smokers or former smokers, a hypothesis that deserves to be further explored in future clinical studies ”.

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New perspectives of care

“The pharmacological association studied in Beverly – underlines Perrone – is registered by the European regulatory body (Ema) – and could be used in patients who, for some reason, were not candidates for treatment with another drug, osimertinib, currently mainly used as a first choice. In addition, it will be useful to explore in further clinical studies whether the addition of drugs that counteract the ability of tumors to build their own blood vessels may also be effective in combination with other drugs directed against the Egfr mutation, particularly in smokers or patients. former smokers at the time of diagnosis ”. In the coming months, the research group of Nicola Normanno, scientific director of the Neapolitan Institute, will conduct the molecular analysis of blood samples (the so-called liquid biopsies) collected before and during the treatment. “Thanks to these analyzes – concludes Perrone – it will be verified whether it is possible to identify groups of patients with greater or lesser probability of benefiting from the treatment with the combination of bevacizumab and erlotinib”.

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