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1、Whatistheoptimalclinicalapplicationsofanti-angiogenic-basedNSCLCstrategiestohelpmorepatientsinthemaintenanceandsecond-linesetting?JohnHeymach,MD,PhDAssociateProfessorThoracic/HeadandNeckMedicalOncologyandCancerBiologyFourthAnnualSymposiumonPersonalizedTherapies
2、andBestClinicalPracticesforLungCancerLosAngeles,CASeptember17,2011DisclosuresAdvisoryboardsforGenentechandAstraZenecaResearchsupportfromAstraZenecaCase#156yowomanwith15pack-yearhistorypresentswithamalignantpleuraleffusion,mediatinaladenopathy,anda3-4smallCNSmet
3、astases.Shehasbeenhavingmildheadachesrecently.Cytologyrevealsadenocarcinoma,TTF1+EGFRmutatationtestingcouldnotbeperformedfromcellblockandadditionalbiopsyrefused.SheisinitiallytreatedwithstereotacticXRTforherCNSlesionsandcomesforsystemictherapy. Whichchemothera
4、pyregimenisnotsupportedbyrandomizedphaseIIIdata?Carbo/pacCarbo/pac/BVPem/cisPem/carbo/BVQuestion1Question#1SheisinitiallytreatedwithstereotacticXRTforherCNSlesionsandcomesforsystemictherapy.WhichchemotherapyregimenisnotsupportedbyrandomizedphaseIIIdata?Carbo/pa
5、cCarbo/pac/BVPem/cisPem/carbo/BVCase#1Sheisstartedontreatmentwithcarboplatin,paclitaxel,andBVx6cycles.Shehasapartialresponse,toleratestreatmentwell,andwantstobetreatedaggressively.WhichmaintenancetherapyispartofaregimenthathasbeenshowntoprolongOSinarandomizedph
6、aseIIIstudy?BVmonotherapyPemetrexedBV+PemBV+erlotinibAandBA,B,andDNomaintenancetherapyQuestion2Question#2WhichmaintenancetherapyispartofaregimenthathasbeenshowntoprolongOSinarandomizedphaseIIIstudy?BVmonotherapyPemetrexedBV+PemBV+erlotinibAandBA,B,andDNomainten
7、ancetherapy12mo.24mo.43.7%16.9%51.9%22.1%0.00.20.40.60.81.0ProbabilityPCPCBP=0.007061218243036MonthsMedians:10.2,12.5HR:0.77(0.65,0.93)PhaseIIITrialofBevacizumab inNon-SquamousNSCLC(ECOG4599)Sandleretal,NEJM2006OverallsurvivalDoesBVmaintenanceprovidebenefitinfi
8、rst-lineNSCLC?InECOG4599,60.1%completed6cyclesofCPBand48%receivedBVmaintenance.44%completed6cyclesofCPwithoutPD.Sandleretal,ProcWorldLungmeeting2011,posterP3.216BVmaintNomai
