The efficacy and safety of bevacizumab in addition to platinum‑based chemotherapy for the first‑line treatment of patients with advanced nonsquamous non‑small‑cell lung cancer: Final results of AVALANCHE, an observational cohort study

Tolnay,Edina; Ghimessy,Áron  Kristóf; Juhász,Erzsébet; Sztancsik,Zsuzsanna; Losonczy,György; Dombi,Péter; Vennes,Zsuzsanna; Helf,László; Csada,Edit; Sárosi,Veronika

doi:10.3892/ol.2018.9766

The efficacy and safety of bevacizumab in addition to platinum‑based chemotherapy for the first‑line treatment of patients with advanced nonsquamous non‑small‑cell lung cancer: Final results of AVALANCHE, an observational cohort study

Authors:
- Edina Tolnay
- Áron Kristóf Ghimessy
- Erzsébet Juhász
- Zsuzsanna Sztancsik
- György Losonczy
- Péter Dombi
- Zsuzsanna Vennes
- László Helf
- Edit Csada
- Veronika Sárosi
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Affiliations: 2nd Department of Pulmonology, Pest County Institute of Pulmonology, Törökbálint 2045, Hungary, Department of Thoracic Surgery, National Institute of Oncology, Budapest 1122, Hungary, 14th Department of Pulmonology and Internal Medicine, National Korányi Institute of Pulmonology, Budapest 1121, Hungary, 1st Department, Békés County Pulmonology Hospital, Gyula 5701, Hungary, Department of Pulmonology, Semmelweis University, Budapest 1125, Hungary, Department of Oncology, Szent Borbála County Hospital, Tatabánya 2800, Hungary, 2nd Department of Internal Medicine, Uzsoki Hospital, Budapest 1145, Hungary, Department of Pulmonology, Bonyhád Hospital, Bonyhád 7150, Hungary, Department of Pulmonology; Faculty of Medicine, University of Szeged, Deszk 6772, Hungary, Department of Pulmonology, University of Pécs, Pécs 7623, Hungary
Published online on: November 27, 2018 https://doi.org/10.3892/ol.2018.9766
Pages: 1750-1760
Copyright: © Tolnay et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The previous results of former clinical studies confirmed that first‑line bevacizumab (BEV) in combination with chemotherapy improves clinical outcomes in patients with advanced non‑squamous non‑small cell lung cancer. The AVALANCHE study (ClinicalTrials.gov Identifier NCT03170284) was undertaken to assess the clinical outcomes of first‑line BEV combined with standard platinum‑based regimens in the Hungarian clinical practice. This observational study was conducted in 28 Hungarian sites, with patients enrolled between July 2008 and April 2011. Patients with untreated locally advanced, metastatic or recurrent lung adenocarcinoma received BEV (7.5 mg/kg, q3w) with any platinum‑doublet for up to 6 cycles, and then non‑progressors proceeded to receive BEV until disease progression or unacceptable toxicity. The primary endpoint was time‑to‑progression, and secondary endpoints included overall survival (OS), tumour control rate and safety. Patients were also analysed as two cohorts (non‑progressors vs. progressors) based on whether or not they received BEV maintenance therapy following completion of first‑line chemotherapy plus BEV. The study enrolled 283 patients (median age: 58.2 (18‑78) years; males: 50.5%; stage: III/B: 18.4%, IV: 79.9%; adenocarcinoma/other: 95.8/4.2%; ECOG PS 0/1/2/≥3: 30.8/59.7/2.6/1.4%). Centrally located tumours were reported in 21.6%. Cisplatin/carboplatin‑based regimens: 53.8/46.2%. A total of 43% of patients received BEV maintenance therapy. The median number of BEV cycles was 6. Median progression‑free survival (PFS) was 7.2 months and OS was 15.2 months for the entire cohort. Longer PFS and OS were observed in patients who received BEV maintenance therapy [median OS, 26.2 vs. 10.2 months (P<0.001); median PFS, 9.2 vs. 5.8 months (P<0.001)]. Contrary to the results of previous OCS no significant difference was recorded in the different age groups or gender. Best tumour response: Complete remission/partial remission/stable disease/progressive disease/not reported were: 1.5/29.9/26.9/9.1/32.6% of all patients. In conclusion, clinical outcomes obtained in this real‑life population were consistent with pivotal studies. BEV maintenance treatment was associated with a significantly longer PFS and OS.

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