Can Osimertinib Plus Bevacizumab Improve Outcomes in Advanced EGFR T790M–Mutated Lung Cancer?
Posted: Monday, April 5, 2021
For patients with EGFR T790M–mutated non–small cell lung cancer, the combination of osimertinib and bevacizumab may increase the overall response rate, according to the West Japan Oncology Group 8715L phase II trial published in JAMA Oncology. However, this combined drug regimen did not demonstrate improvements in progression-free or overall survival in this patient population, explained Nobuyuki Yamamoto, MD, PhD, of Wakayama Medical University, Japan, and colleagues.
From 2017 to 2018, a total of 87 patients with progressively advanced lung adenocarcinoma were recruited for the study. All patients had received previous EGFR–tyrosine kinase inhibitor therapy and subsequently developed EGFR T790M mutation. Patients were randomly assigned to receive either combination therapy of 80 mg of osimertinib daily plus 15 mg/kg of bevacizumab every 3 weeks or 80 mg of osimertinib alone.
The study revealed an increased overall response rate for patients receiving osimertinib plus bevacizumab (68%) compared with osimertinib alone (54%). However, there was no notable improvement in progression-free survival (hazard ratio = 1.44) or median overall survival in those given the combination therapy. In addition, there was a reduced duration in the median time to treatment failure for patients receiving the combination therapy (8.4 months) compared with osimertinib monotherapy (11.2 months). Furthermore, patients who received the combination therapy commonly experienced adverse effects, including proteinuria (23%) and hypertension (20%).
“It is, therefore, possible to speculate that exposure to prior treatment and tumor regrowth could confer microenvironmental changes of the tumor that lead to resistance to anti-VEGF agents,” reported Dr. Yamamoto and colleagues.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.