EUREKA-EUREKA

NEW YORK (Reuters Health) Apr 30 - Heavily pretreated patients with advanced, chemoresistant small-cell lung cancer may gain some benefit from paclitaxel plus bevacizumab, Greek researchers say.

The combination "confers clinical benefit with minimal toxicity," Dr. Giannis Mountzios told Reuters Health by email.

These patients don't have many options, and the options that do exist - such as cyclophosphamide, doxorubicin and vincristine, for example -- produce substantial toxicity, Dr. Mountzios of 251 Air Force General Hospital, Athens, and the Hellenic Oncology Research Group noted in a report online March 15 in Lung Cancer.

Paclitaxel and bevacizumab, a vascular endothelial growth factor inhibitor, have both shown activity against solid tumors. In a phase II trial, the authors treated 30 patients with paclitaxel 90 mg/m2 on days 1, 8 and 15, plus bevacizumab 10 mg/kg on days 1 and 15, in 28-day cycles.

All of the patients had an Eastern Cooperative Oncology Group performance status of 0 to 2 (meaning that at a minimum, they were ambulatory and capable of all self-care, but unable to work). They had all relapsed within three months of finishing their first line chemotherapy. Nineteen had received at least two lines of prior treatment, 17 had undergone radiotherapy, and nine had brain metastases.

The overall objective response rate was 20%, with one complete remission. The disease control rate was 36.7%.

The median for progression-free survival was 2.7 months, but the top of the range was 9.2 months. Median overall survival was 6.3 months.

These results, say the investigators "are comparable to other, substantially more toxic regimens, currently used in second-line treatment."

Over the course of 84 chemotherapy cycles, there were eight hematologic and four non-hematologic serious (grades 3 or 4) adverse events. One patient had a non-fatal pulmonary embolism possibly related to bevacizumab.

The researchers call for further evaluation, pointing out that the combination "yields efficacy results equivalent to those of cytotoxic combinations, while obviating substantial toxicity that can be devastating for these frail patients."