Author of

• 11001

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  P1.24 - Poster Session 1 - Clinical Care (ID 146)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11008

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    P1.24-007 - Long-term maintenance therapy with bevacizumab for Chinese advanced non-small cell lung cancer: a case report (ID 783)

    09:30 - 09:30  |  Author(s): J. Tang
    • Abstract

    Background
    Phase IV Safety of Avastin in Lung (SAiL) study was conducted to determine the safety and efficacy of first-line bevacizumab plus standard chemotherapy regimens in a broad patient population. Herein, we report a Chinese female patient enrolled in SAiL study who received chemotherapy and subsequent bevacizumab maintenance for 39 months.

    Methods
    not applicable

    Results
    A 59-year-old female presented with a cough for 6 months, and was admitted to our hospital on December 2007. CT scan showed multiple patchy shadows in both lungs, multiple nodular shadows in the right pleura, and mediastinal lymph node enlargement. CT-guided biopsy of the lower left lung showed adenocarcinoma, and biopsy of the right supraclavicular lymph nodes confirmed metastasis. The patient was a non-smoker, and was negative for EGFR and KRAS gene mutations, and negative for EML4-ALK rearrangement. From January, 2008, this patient was enrolled in the SAiL study and received bevacizumab(15 mg/kg) plus paclitaxel(175 mg/m[2])/carboplatin(AUC=6) for 6 cycles. Re-examination was performed at cycles 2, 4, and 6, and the results showed the target lesion was reduced by 9.4%, 32.9%, and 22.9%, respectively. The non-target lesions were stable and no new lesions were noted. The therapeutic efficacy was defined as PR, and re-examination was carried out every 6 weeks. After 6 cycles of chemotherapy, maintenance bevacizumab was begun (15 mg/kg) every 3 weeks and continued until March, 2011. A total of 42 cycles of bevacizumab were administered, for a total dose of 44,730 mg. CT in April 2011 showed the target lesion and the non-target lesions had increased, and new metastatic nodules were also found. The therapeutic efficacy was defined as PD. The last follow-up visit was in Apr 2012, PFS was 39 months and OS was 52 months. During maintenance therapy with bevacizumab, the main side effects included proteinuria, secondary hypertension, and pneumothorax. Secondary hypertension was observed after 6 months of bevacizumab, and controlled with nifedipine extended-release tablets. At 7 months from beginning bevacizumab, urinalysis showed proteinuria (++) and bevacizumab maintenance was continued with no dose decrease. According to the protocol, a 24-h urine protein level was obtained every 3 weeks. When the urine protein level was <2,000 mg/24h, bevacizumab maintenance was continued, and if the level was ≥2,000 mg/24h, treatment was discontinued and re-examination of the urine protein level was carried out every 3 weeks. Bevacizumab maintenance was continued when the 24-h urine protein decreased to <2,000 mg/24h. After 19 months of bevacizumab, the patient's urine protein level was >2,000 mg/24h, when treatment was discontinued. Between August 2009 and March 2011, bevacizumab maintenance therapy was stopped several times; the longest duration of discontinuation was 3 months. The maximal 24-h urine protein level was 3,926 mg/24h (grade 3), which was noted 33 months after beginning bevacizumab. It is noteworthy that 12 months after discontinuation of bevacizumab, urinalysis still showed proteinuria (+). Spontaneous pneumothorax of her left lung occurred 36 months after initiation of bevacizumab and chemotherapy. The patient experienced no symptoms, and after 1 month CT showed full expansion of the left lung.

    Conclusion
    not applicable