Document Type
Article
Publication Date
12-1-2019
Abstract
PURPOSE: We evaluated the addition of bevacizumab, a humanized monoclonal antibody that targets vascular endothelial growth factor, to platinum-based chemotherapy in recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN).
PATIENTS AND METHODS: Patients with chemotherapy-naïve (or with prior platinum as part of multimodal therapy completed ≥ 4 months earlier) recurrent or metastatic SCCHN were randomly assigned to receive a platinum-based chemotherapy doublet with or without bevacizumab 15 mg/kg given intravenously every 3 weeks until disease progression. Chemotherapy could be discontinued after six cycles if a maximum response was achieved.
RESULTS: The study randomly assigned 403 patients. Median overall survival (OS) was 12.6 months with bevacizumab plus chemotherapy (BC) and 11.0 months with chemotherapy alone (hazard ratio, 0.87; 95% CI, 0.70 to 1.09; P = .22). At 2, 3, and 4 years, the OS rates were 25.2% v 18.1%, 16.4% v 10.0%, and 11.8% v 6.4% for BC versus chemotherapy, respectively. In an analysis of 365 eligible patients who started treatment, the hazard ratio was 0.82 (95% CI, 0.65 to 1.04; P = .10), with a median OS of 14.2 months on BC v 11.1 months on chemotherapy. Median progression-free survival with BC was 6.0 months v 4.3 months with chemotherapy (P = .0014). Overall response rates were 35.5% with BC and 24.5% with chemotherapy (P = .016). There was increased toxicity, including a higher rate of treatment-related grade 3 to 5 bleeding events (6.7% v 0.5%; P < .001) and treatment-related deaths (9.3% v 3.5%; P = .022) with BC versus chemotherapy.
CONCLUSION: The addition of bevacizumab to chemotherapy did not improve OS but improved the response rate and progression-free survival with increased toxicities. These results encourage biomarker-driven studies of angiogenesis inhibitors with better toxicity profiles in select patients with SCCHN.
Recommended Citation
Argiris, Athanassios; Li, Shuli; Savvides, Panayiotis; Ohr, James P.; Gilbert, Jill; Levine, Marshall A.; Chakravarti, Arnab; Haigentz, Missak; Saba, Nabil F.; Ikpeazu, Chukwuemeka V.; Schneider, Charles J.; Pinto, Harlan A.; Forastiere, Arlene A.; and Burtness, Barbara, "Phase III Randomized Trial of Chemotherapy With or Without Bevacizumab in Patients With Recurrent or Metastatic Head and Neck Cancer." (2019). Department of Medical Oncology Faculty Papers. Paper 106.
https://jdc.jefferson.edu/medoncfp/106
PubMed ID
31618129
Language
English
Comments
This article is the author’s final published version in the Journal of Clinical Oncology, Volume 37, Issue 34, December 2019, Pages 3266-3274.
The published version is available at https://doi.org/10.1200/JCO.19.00555. Copyright © Argiris et al.