Earlier this year, I described the preliminary reported results from the AVAPERL trial, enrolling patients with first line treatment of advanced nonsquamous NSCLC with four cycles of cisplatin/Alimta (pemetrexed)/Avastin (bevacizumab), then assigned patients who hadn’t progressed to either four cycles to either maintenance Alimta/Avastin or Avastin as a single agent. At the 2011 meeting of the European Society for Medical Oncology (ESMO), the investigators (Barlesi and colleagues) presented early results revealing a very significant improvement in progression-free survival (PFS) from the beginning of treatment (from the time of starting first line), at 10.2 vs. 6.6 months (HR 0.50, p < 0.001), as shown in the figure below:
(click on image to enlarge)
Looking at the results plotted from the time of randomization to combination vs. single agent Avastin as maintenance therapy provides an even more striking distinction between the two arms:
Back in September, I didn’t have any information about overall survival (OS), but here’s the preliminary OS results, with numbers from the time of starting all treatment:
While these results are preliminary, the difference of a 25% better OS with continuation of Alimta is impressive to me, especially considering that the arm that received maintenance Avastin alone, while the inferior arm here, has a median survival of nearly 16 months: we would consider that result to be excellent in the context of other advanced NSCLC trials (for instance, 12 months for cisplatin/Alimta on one large phase III randomized trial, 12 months with carboplatin/Taxol (paclitaxel) with Avastin in another). So we can’t say that the Avastin alone arm underperformed — it did quite well, but the Avastin/Alimta arm did remarkably well.
