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Lancet. 2016 Apr 2;387(10026):1405-1414. doi: 10.1016/S0140-6736(15)01238-6. Epub 2015 Dec 21.

Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial.

Author information

1
Department of Pulmonology and Thoracic Oncology, University of Caen, Centre Hospitalier Universitaire Côte de Nacre, Caen, France; Department of Thoracic Oncology, Centre d'investigation clinique Institut national de la santé et de la recherche médicale 1425, Hospital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Paris-Diderot University (Paris 7), Paris, France. Electronic address: gerard.zalcman@aphp.fr.
2
Department of Pulmonology, Larrey Hospital, Toulouse, France.
3
Gustave Roussy Institute, Villejuif, France.
4
Assistance Publique Hôpitaux du Marseille, Marseille, France.
5
Department of Pulmonology, Centre Hospitalier Intercommunal Toulon, Toulon, France.
6
Pôle Thorax and Vaisseaux Centre Hospitalier Universitaire Grenoble, Grenoble, France.
7
Department of Pulmonology, Centre Hospitalier Le Mans, Le Mans, France.
8
Department of Pulmonology, Ponchaillou University Hospital, Rennes, France.
9
Department of Pulmonology, Centre Hospitalier Intercommunal Créteil, Créteil, France.
10
Hôpital Tenon, Assistance Publique Hopitaux du Paris, Paris, France.
11
Department of Pulmonology, Hôpital d'instruction des armées Percy, Clamart, France.
12
Department of Pulmonology, Gabriel-Montpied University Hospital, Clermont-Ferrand, France.
13
Centre régional de lutte contre le cancer François Baclesse, Caen, France.
14
Department of Pulmonology, Centre Hospitalier Meaux, Meaux, France.
15
French Cooperative Thoracic Group, Paris, France.
16
Department of Biostatistics and Clinical Research, Centre Hospitalier Universitaire Côte de Nacre, Caen, France; Equipe d'Accueil 4655, Caen Normandy University, Caen, France.
17
Pulmonary and Thoracic Oncology Department, Centre Hospitalier Universitaire Lille, University of Lille, U1019 Institut national de la santé et de la recherche médicale, Centre d'Infection et d'Immunité de Lille, Lille, France.

Erratum in

Abstract

BACKGROUND:

Malignant pleural mesothelioma is an aggressive cancer with poor prognosis, linked to occupational asbestos exposure. Vascular endothelial growth factor is a key mitogen for malignant pleural mesothelioma cells, therefore targeting of vascular endothelial growth factor might prove effective. We aimed to assess the effect on survival of bevacizumab when added to the present standard of care, cisplatin plus pemetrexed, as first-line treatment of advanced malignant pleural mesothelioma.

METHODS:

In this randomised, controlled, open-label, phase 3 trial, we recruited patients aged 18-75 years with unresectable malignant pleural mesothelioma who had not received previous chemotherapy, had an Eastern Cooperative Oncology Group performance status of 0-2, had no substantial cardiovascular comorbidity, were not amenable to curative surgery, had at least one evaluable (pleural effusion) or measurable (pleural tumour solid thickening) lesion with CT, and a life expectancy of >12 weeks from 73 hospitals in France. Exclusion criteria were presence of central nervous system metastases, use of antiaggregant treatments (aspirin ≥325 mg per day, clopidogrel, ticlopidine, or dipyridamole), anti-vitamin K drugs at a curative dose, treatment with low-molecular-weight heparin at a curative dose, and treatment with non-steroidal anti-inflammatory drugs. We randomly allocated patients (1:1; minimisation method used [random factor of 0·8]; patients stratified by histology [epithelioid vs sarcomatoid or mixed histology subtypes], performance status score [0-1 vs 2], study centre, or smoking status [never smokers vs smokers]) to receive intravenously 500 mg/m(2) pemetrexed plus 75 mg/m(2) cisplatin with (PCB) or without (PC) 15 mg/kg bevacizumab in 21 day cycles for up to six cycles, until progression or toxic effects. The primary outcome was overall survival (OS) in the intention-to treat population. Treatment was open label. This IFCT-GFPC-0701 trial is registered with ClinicalTrials.gov, number NCT00651456.

FINDINGS:

From Feb 13, 2008, to Jan 5, 2014, we randomly assigned 448 patients to treatment (223 [50%] to PCB and 225 [50%] to PC). OS was significantly longer with PCB (median 18·8 months [95% CI 15·9-22·6]) than with PC (16·1 months [14·0-17·9]; hazard ratio 0·77 [0·62-0·95]; p=0·0167). Overall, 158 (71%) of 222 patients given PCB and 139 (62%) of 224 patients given PC had grade 3-4 adverse events. We noted more grade 3 or higher hypertension (51 [23%] of 222 vs 0) and thrombotic events (13 [6%] of 222 vs 2 [1%] of 224) with PCB than with PC.

INTERPRETATION:

Addition of bevacizumab to pemetrexed plus cisplatin significantly improved OS in malignant pleural mesothelioma at the cost of expected manageable toxic effects, therefore it should be considered as a suitable treatment for the disease.

FUNDING:

Intergroupe Francophone de Cancérologie Thoracique (IFCT).

PMID:
26719230
DOI:
10.1016/S0140-6736(15)01238-6
[Indexed for MEDLINE]

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