Even though chemoradiotherapy (CRT) is the standard of care for patients with unresectable stage III non–small-cell lung cancer (LA-NSCLC), most patients relapse. Tecemotide is a MUC1 antigen-specific cancer immunotherapy vaccine. Bevacizumab improves survival in advanced nonsquamous (NS)-NSCLC and has a role in immune modulation.
Researchers wanted to understand the significance of the phase II trial that tested the combination of tecemotide and bevacizumab following CRT in patients with LA-NSCLC.
Patients with stage III NS-NSCLC suitable for CRT received carboplatin/paclitaxel weekly + 66 Gy followed by 2 cycles of consolidation carboplatin/paclitaxel less than or equal to 4 weeks of completion of CRT (Step 1). Patients with partial response/stable disease after consolidation therapy were registered onto step 2, which was 6 weekly tecemotide injections followed by every 6 weekly injections and bevacizumab every 3 weeks for up to 34 doses. The preliminary endpoint was to determine the safety of this regimen.
Seventy patients were enrolled; 68 patients (median age, 63 years; 56% male; 57% stage IIIA) initiated therapy, but only 39 patients completed CRT and consolidation therapy per protocol, primarily owing to disease progression or toxicity. Thirty-three patients were enrolled in step 2 (tecemotide + bevacizumab). The average number of step 2 cycles was 11. (range, 2-25). Grade 3, N = 9, grade 4, N = 1, and grade 5, N = 1 were the worst toxins in Step 2. Bevacizumab was attributed for esophageal perforation, a grade 5 toxicity. From step 1 registration, the median overall survival was 42.7 months (95% CI, 21.7-63.3 months) and the median progression-free survival was 14.9 months (95% CI, 11.0-20.9 months) among the treated and eligible patients (n = 32).
This cooperative group study attained its primary goal of proving bevacizumab + tecemotide tolerance following CRT and consolidation. The median progression-free survival and overall survival rates in this group of patients are both promising. Considering that consolidation immunotherapy is currently standard of care in patients with LA-NSCLC after CRT, these findings suggest the need for more research into antiangiogenic and immunotherapy combinations in this disease.
Reference link-www.clinical-lung-cancer.com/article/S1525-7304(20)30189-3/fulltext
