A phase II study of bevacizumab with carboplatin-pemetrexed in non-squamous non-small cell lung carcinoma patients with malignant pleural effusions: North East Japan Study Group Trial NEJ013A

Usui, Kazuhiro; Sugawara, Shunichi; Nishitsuji, Masaru; Fujita, Yuka; Inoue, Akira; Mouri, Atsuto; Watanabe, Hiroshi; Sakai, Hiroshi; Kinoshita, Ichiro; Ohhara, Yoshihito; Maemondo, Makoto; Kagamu, Hiroshi; Hagiwara, Koichi; Kobayashi, Kunihiko

doi:10.1016/j.lungcan.2016.07.003

Cited by 40 publications

(54 citation statements)

References 26 publications

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“…A phase II study including 23 patients with NSCLC‐induced MPE administered bevacizumab with carboplatin‐paclitaxel therapy, yielding an MPE control rate of 91.3% . Another phase II study of bevacizumab with carboplatin‐pemetrexed reported an MPE control rate without pleurodesis at 8weeks of 92.8%, similar to our findings at 6 and 12 weeks …”

Section: Discussionsupporting

confidence: 87%

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Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma‐induced malignant pleural effusion

Hong

Meng

et al. 2018

Thoracic Cancer

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BackgroundVEGF is critical in the pathogenesis of malignant pleural effusion (MPE). To understand the clinical benefits of antiangiogenic agents, the efficacy of chemotherapy containing bevacizmab was investigated in patients with lung adenocarcinoma‐induced MPE.MethodsThe data of lung adenocarcinoma patients with MPE treated with bevacizumab plus chemotherapy on day 1, every three weeks, for ≤ 6 cycles was retrospectively collected. Patients who achieved a response or stable disease were administered bevacizumab as maintenance therapy until progression. The primary outcomes of the study were MPE response rate (RR), MPE control rate, and pleural progression‐free survival (PPFS), while the secondary outcomes were PFS, overall survival (OS), changes to the lung volume and thoracic cage, and safety profiles.ResultsA total of 21 cases were collected, and all were evaluable for response, including 15 chemotherapy‐naïve patients and 6 who experienced relapse. The median cycle of treatments was 7 (1‐42) and 5 (2‐6) for bevacizumab and chemotherapy, respectively. The MPE RR reached 81.0%. The MPE control rate at 6, 12, 24, 48, and 96 weeks were 95.2%, 90.0%, 89.5%, 73.7%, and 43.8%, respectively. Median PPFS was significantly longer than PFS (22.2 vs. 7.8 months; P = 0.044), and median OS was 25.8 months. Nineteen (90.5%) patients experienced lung re‐expansion after treatment. Only one (4.8%) patient suffered thoracic volume decrease during treatment and the follow‐up period. No unexpected adverse events were observed.ConclusionsBevacizumab combined with chemotherapy demonstrated efficacious, persistence, and safety in controlling lung cancer‐induced MPE, indicating a potential superior therapeutic option.

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Section: Discussionsupporting

confidence: 87%

“…Bevacizumab has been reported to reduce the accumulation of MPE in animal models . The use of bevacizumab with chemotherapy to treat MPE has been explored in small‐scale clinical trials . Although this therapy seemed effective, the long‐term influence of combined therapy has not received sufficient attention.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma‐induced malignant pleural effusion

Hong

Meng

et al. 2018

Thoracic Cancer

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“…Blockade of VEGF signaling by either antibodies (bevacizumab) or inhibitors (ZD6474, vandetanib) has been tested experimentally 94,95. A recent Phase II clinical trial showed that the addition of bevacizumab to carboplatin–pemetrexed chemotherapy for non-small-cell lung cancer resulted in MPE control without pleurodesis 96. Additionally, cancer immunotherapy, the concept of stimulating the innate immune response against cancer cells, has been tested in previous clinical trials with promising results.…”

Section: Challengesmentioning

confidence: 99%

Management of malignant pleural effusion: challenges and solutions

Penz

Watt

Hergott

et al. 2017

CMAR

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Malignant pleural effusion (MPE) is a sign of advanced cancer and is associated with significant symptom burden and mortality. To date, management has been palliative in nature with a focus on draining the pleural space, with therapies aimed at preventing recurrence or providing intermittent drainage through indwelling catheters. Given that patients with MPEs are heterogeneous with respect to their cancer type and response to systemic therapy, functional status, and pleural milieu, response to MPE therapy is also heterogeneous and difficult to predict. Furthermore, the impact of therapies on important patient outcomes has only recently been evaluated consistently in clinical trials and cohort studies. In this review, we examine patient outcomes that have been studied to date, address the question of which are most important for managing patients, and review the literature related to the expected value for money (cost-effectiveness) of indwelling pleural catheters relative to traditionally recommended approaches.

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“…However, there are few reports about the influence of systemic treatment on MPE recurrence, specifically in NSCLC (10,11,12,38,39 (38) during a median follow-up period of 1,050 days. Our study did not evaluate any specific treatment such as the abovementioned ones, but the association between the systemic treatment phase in which the patient was and MPE recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have assessed MPE recurrence in NSCLC patients (10)(11)(12) and aimed to evaluate the influence of systemic Original Article Wet M1a non-small cell lung cancer: is it possible to predict recurrence of pleural effusion? treatment on MPE control.…”

Section: Introductionmentioning

confidence: 99%

Wet M1a non-small cell lung cancer: is it possible to predict recurrence of pleural effusion?

Irlb

et al. 2018

J. Thorac. Dis.

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Background:The propose was to recognize risk factors of malignant pleural effusion (MPE) recurrence in patients with symptomatic M1a non-small cell lung cancer (NSCLC). Methods: All patients with NSCLC and MPE submitted to pleural palliative procedures were enrolled in a prospective study. Group I contained patients who had pleural recurrence, and Group II with no pleural recurrence. Prognostic factors for pleural recurrence were identified by univariable analysis, using Fisher's exact test for categorical variables and Student's t test for quantitative variables. Afterwards the significant variables were entered into a multivariable logistic regression analysis (with P<0.05 considered significant).Receiver operating characteristics (ROC) analysis determined the cutoff points for continuous variables. Results: A total of 82 patients were included in the analysis. There were 15 patients (18.3%) in Group I and 67 patients (81.7%) in Group II. Univariable analysis regarding factors affecting postoperative recurrence was: adenosine deaminase concentration in pleural fluid <16 mg/dL (P=0.04), albumin concentration in pleural fluid <2.4 mg/dL (P=0.03), administration of second-line palliative chemotherapy (P=0.018) and type of procedure [therapeutic pleural aspiration (TPA)] (P=0.023). At the multivariable analysis, only the type of procedure (TPA) (P=0.031) was identified as independent predictor of recurrence. Conclusions:The identification of this factor may assist the choice of the optimal palliative technique; at the first episode of MPE in NSCLC patients and definitive procedure as pleurodesis or indwelling pleural catheter are recommended.

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A phase II study of bevacizumab with carboplatin-pemetrexed in non-squamous non-small cell lung carcinoma patients with malignant pleural effusions: North East Japan Study Group Trial NEJ013A

Cited by 40 publications

References 26 publications

Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma‐induced malignant pleural effusion

Outcomes of bevacizumab combined with chemotherapy in lung adenocarcinoma‐induced malignant pleural effusion

Management of malignant pleural effusion: challenges and solutions

Wet M1a non-small cell lung cancer: is it possible to predict recurrence of pleural effusion?

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