Anti-angiogenic therapy in advanced non-small cell lung carcinoma (NSCLC): is there a role in subsequent lines of therapy?

Abdulaziz Al Farsi, Peter M. Ellis


Early in 2014, Reck and colleagues published the results of the LUME Lung-1 trial in Lancet Oncology (1). This trial evaluated the addition of nintedanib, an oral triple angiokinase inhibitor or placebo, to standard second-line chemotherapy with docetaxel. The trial, conducted largely in European countries, randomized 1,314 patients to docetaxel plus nintedanib 200 mg twice daily, or docetaxel plus placebo. Treatment continued until disease progression, or unacceptable toxicity. Eligible patients had stage IIIB/IV or recurrent non-small cell lung carcinoma (NSCLC) that had progressed after first-line chemotherapy. Patients with contraindications to the use of VEGF-R directed therapy (untreated brain metastases, underlying major bleeding or thrombotic disorders, cavitatory lesions, lesions invading major blood vessels and a history of hemoptysis) were excluded. Prior therapy with bevacizumab was allowed, although fewer than 5% of patients in both arms had previously received bevacizumab. Stratification was based on Eastern Cooperative Oncology Group (ECOG) performance status (0 vs.1), prior bevacizumab therapy (yes vs.no), squamous versus non squamous histology, and the presence of brain metastases (yes vs. no). The primary outcome was progression free survival (PFS).

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