Lung cancer – another step in the right direction

Oncologists were today treated to some positive news in the fight against lung cancer at the Australia and New Zealand joint scientific meeting for the Medical Oncology Group of Australia and the Faculty of Radiation Oncology, held in Christchurch NZ.

As you know, there has long been therapeutic nehalism regarding the treatment of lung cancer. Delegates at the conference saw two excellent presentations which highlighted the emerging role of targeted therapies combined with chemotherapy for the treatment of lung cancer.

The first study presented by Dr Arlene Chan medical oncologist at the Mount Hospital Perth focused on the AVADO trial. It recruited 736 patients from 106 sites in 24 countries. Patients were randomized to receive either: docetaxel 100mg/m2 plus placebo; or docetaxel 100mg/m2 plus 7.5 mg/kg bevacizumab; or docetaxel 100mg/mg2 plus bevacizumab 15mg/kg given three-weekly.

The primary endpopint was progression free survival and median follow up was 10.2 months. The patient characteristics were evenly balanced in each of the arms and there was the usual mild excess of diarrhoea, rash and hypertension in the bevacizumab arms. Essentially, the treatment in each arm was well tolerated.

The progression free survival (PFS) was statistically better in each of the bevacizumab arms, with the hazard ratio (HR) for PFS being 0.79 in the docetaxel 100mg/m2 plus 7.5 mg/kg bevacizumab arm and 0.72 in the docetaxel 100mg/mg2 plus bevacizumab 15mg/kg arm.

Median PFS was 8.0 months for docetaxel alone, 8.7 months for docetaxel 100mg/mg2 plus bevacizumab 7.5mg/kg and 8.8 months for docetaxel 100mg/mg2 plus bevacizumab 15mg/kg.

Overall response rate was 44%, 55% and 63% respectively. Interestingly, the docetaxel plus bevacizumab arms compared very favourably (historically) with some treatment doublets including docetaxel plus capecitabine, paclitaxel plus gemcitabine, docetaxel plus gemcitabine.

As far as overall survival (OS) is concerned, median OS has not yet been reached, however on the basis of data gathered so far, the HR has dropped to 0.92 in the docetaxel 100mg/mg2 plus bevacizumab 7.5mg/kg arm and 0.68 in the docetaxel 100mg/mg2 plus bevacizumab 15mg/kg arm.

One year survival data so far is 73% for docetaxel 100mg/m2 plus placebo, 78% for docetaxel 100mg/mg2 plus bevacizumab 7.5mg/kg, 83% docetaxel 100mg/mg2 plus bevacizumab 15mg/kg.

All of the assembled oncologists will await the median OS with bated breath.