Combination of Bevacizumab and Erlotinib prolongs PFS in patients with EGFR-mutated NSCLC


Although many tyrosine kinase inhibitors (TKIs) have been approved by FDA to treat EGFR-mutated NSCLC, the disease of more than half patients ultimately progress within a year after EGFR-TKI monotherapy. In order to overcome this efficacy limitation of EGFR-TKIs, the phase III NEJ026 trial enrolled 228 chemotherapy-naïve patients with advanced, EGFR-mutant NSCLC and randomly assigned them to receive either erlotinib (150 mg) or a combination of erlotinib (150 mg) and bevacizumab (15 mg/kg) intravenously every 3 weeks. The median PFS was 16.6 months in the combination group and 12.4 months in the erlotinib monotherapy (HR, 0.563; 95% CI, 0.394-0.804; P = 0.00057). The subgroup analysis (in patients with EGFR exon 19 deletion or EGFR exon 21 L858R mutation) showed similar results. The incidence of grade ≥3 AEs were 56.3% and 37.7% in the combination arm and the erlotinib arm, respectively. These results showed that the combination of an EGFR-TKI plus a VEGF inhibitor can benefit the patients with EGFR-mutated NSCLC, despite higher AE rates.