Combination Therapy for Previously Untreated Advanced Lung Cancer
In the phase III SWOG S0819 trial, there appeared to be no overall survival benefit in the addition of cetuximab to carboplatin/paclitaxel with and without bevacizumab in patients with previously untreated stage IV non–small cell lung cancer (NSCLC). However, a select subgroup of patients—those with EGFR fluorescence in situ hybridization (FISH)-positive squamous cell carcinoma—did seem to obtain a survival benefit with the EGFR-targeting antibody cetuximab. These findings were published in The Lancet Oncology by Roy S. Herbst, MD, PhD, of the Yale Cancer Center, and colleagues.
The open-label phase III study involved 1,313 patients from 277 sites in the United States and Mexico. The patients were randomly assigned to either the control group (paclitaxel plus carboplatin or paclitaxel plus carboplatin and bevacizumab) or the group with cetuximab (cetuximab plus paclitaxel and carboplatin with or without bevacizumab).
In the entire study population, overall survival was similar between the treatment groups (10.9 months in the cetuximab group vs. 9.2 months in the control group). Overall and progression-free survival did not differ among patients who were EGFR FISH non-positive with squamous cell histology. In EGFR FISH-positive patients with squamous cell carcinoma, median overall survival with cetuximab was 11.8 months versus 6.1 months without; a nonsignificant improvement in median progression-free survival (4.5 vs. 2.8 months) was also reported.