Bevacizumab extends survival of pleural mesothelioma patients

By Shreeya Nanda, Senior medwireNews Reporter

Patients with unresectable, malignant pleural mesothelioma derive a significant survival benefit from the addition of bevacizumab to standard treatment according to phase III trial findings published in The Lancet.

In the open-label Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS) trial, a total of 448 newly diagnosed patients aged 18–75 years were randomly assigned to receive the standard of care, cisplatin plus pemetrexed, either with or without bevacizumab 15 mg/kg for no more than six cycles of 21 days.

After a median follow-up of 39.4 months, the risk of death from any cause was reduced by a significant 23% for the 223 patients in the bevacizumab group relative to the 225 patients in the chemotherapy alone group. The corresponding median overall survival times were 18.8 and 16.1 months.

This 2.7-month improvement “could be viewed as slight”, say the MAPS investigators, “but it still accounts for the longest [overall survival] ever obtained in a large controlled trial of pleural mesothelioma”.

Progression-free survival was also significantly extended by the addition of the vascular endothelial growth factor inhibitor, at a median of 9.2 months compared with 7.3 months for the chemotherapy alone arm.

Adverse events of grade 3 or 4 were more frequent among patients given bevacizumab plus chemotherapy compared with those given chemotherapy alone (71 vs 62%), with grade 3 or worse thromboembolic events, hypertension and haemorrhage more common in the former group and anaemia in the latter.

The researchers say, however, that the side effects were “expected and manageable”.

Therefore, Gerard Zalcman (University of Caen, France) and colleagues believe that the three-drug combination “should be considered as a new treatment option for patients with newly diagnosed mesothelioma who are eligible to receive bevacizumab and who are not candidates for curative-intent surgery.”

Commentator Marjorie Zauderer (Memorial Sloan Kettering Cancer Center, New York, USA) agrees in a linked piece that bevacizumab, cisplatin plus pemetrexed could be “a new standard of care” in this patient population.

She points out that the improvements in survival outcomes occurred despite a higher rate of toxicity-related discontinuation in the bevacizumab than in the chemotherapy alone treatment arm (24.3 vs 6.0%).

But while the results are “impressive”, Zauderer thinks that unanswered questions remain, such as the role of bevacizumab in patients older than 75 years of age and those who are unable to tolerate cisplatin. 

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