Author of

• 18973

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  P2.01 - Advanced NSCLC (ID 618)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Advanced NSCLC
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/17/2017, 09:00 - 16:00, Exhibit Hall (Hall B + C)

  • 23132

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    P2.01-009 - The Efficacy of Bevacizumab Adding in Standard First Line Chemotherapy and Maintenance Treatment in Advanced NSCLC: A Network Meta-Analysis (ID 7977)

    09:00 - 09:00  |  Author(s): A. Thakkinstian
    • Abstract
    • Slides

    Background:
    Bevacizumab (bev) is used as a standard first-line treatment in combination with doublet platinum-based chemotherapy and as the maintenance therapy with either bev alone or bev with single agent chemotherapy for advanced non-small cell lung cancer (NSCLC). However, it was not well established which is the best chemotherapy of bev combination regimen and which is the optimal dose of bev in this setting.
    
    Method:
    Phase II-III RCTs of bev containing regimens of a first line and maintenance treatment of advanced NSCLC were identified from PubMed and Scopus databases until 20 February 2017. Data was independently reviewed and extracted by two oncologists. Network meta-analysis was performed to assess the efficacy of bev in both the induction and maintenance phase. We estimate the probability of being the best combination regimen with bev using surface under the cumulative ranking curve (SUCRA) analysis. This analysis was registered with PROSPERO (CRD42016027171).
    
    Result:
    All 4,108 studies were identified from PubMed and Scopus databases. After removal of duplications and exclude ineligible studies, 27 RCTs were included. Studies were analyzed by the period of treatment as at induction period and at maintenance period. Induction treatment with platinum+pemetrexed (pem) showed a strongest benefit to control disease [RR 1.33 (95% 1.05-1.70)]. Bev is best to combine with platinum+taxane [RR 1.26 (95%CI 1.06- 1.50)]. Low dose bev (7.5 mg/kg) and standard dose bev+doublet of platinum and taxane are comparable for controlling disease [(RR 1.00 (95%CI 0.73-1.36)]. Maintenance treatment with pem+bev could be the most effective regimen to prevent disease progression and to improve response rate, however the regimen was the first rank of increasing death from adverse event [RR 3.2 (95%CI 1.11-9.21)]. Maintenance with low dose bev could control disease and also decrease both cancer-specific death and all causes of death. Risk-of-bias assessment was done and the majority of the included RCTs are low risk of bias.
    
    Conclusion:
    Bev is best to combine with doublet of platinum and taxane for induction treatment. Adding bev to doublet platinum with pem may not enhance more efficacy of induction treatment. Maintenance with low dose bev is applicable given that it had lower toxicity profiles than a conventional dose (15 mg/kg) without significant differences of benefit. Maintenance with pem+bev could decrease death from cancer and all cause of death, however there was a very high toxicity profile. Therefore, pem+bev might be the option for only selected patients with good performance status in maintenance treatment.
    
    

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