Update in Oncology

Update in Oncology

Lowell E. Schnipper, MD*

From Beth Israel Deaconness Medical Center, Boston, Massachusetts.

2007 Series: Update Sessions from Internal Medicine 2007

This Update in Oncology reviews the most important articles relevant to oncology that were published in 2006. The Table summarizes changes to clinical practice that should emerge from these articles. They reflect improvement in the use of standard chemotherapy for ovarian and gastric cancers, guidance for managing patients with type II Lynch syndrome, possible new screening approaches for lung cancer, and application of targeted molecular therapies to important clinical problems.

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Table. Changes to Clinical Practice Emerging from Articles Important to Oncologists in 2006

Lung Cancer

Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355:2542-50. [PMID: 17167137]

Question: Does the addition of bevacizumab to standard chemotherapy improve survival in patients with advanced non–small-cell lung cancer?

Study Design: Prospective phase III randomized trial.

Patients: 878 patients with recurrent or advanced non–small-cell lung cancer (stage IIIB or IV) who had not previously received chemotherapy and had adequate performance status and adequate hematologic, hepatic, and renal function. Patients were excluded if they were pregnant or lactating; had squamous-cell tumors or brain metastatic tumors; had hemoptysis, coagulopathy, or therapeutic anticoagulation, or were regularly receiving antiplatelet agents; had received radiation therapy within 21 days or major surgery within 28 days before enrollment; or had clinically significant cardiovascular disease or medically uncontrolled hypertension.

Setting: More than 100 medical centers in the United States.

Intervention: Paclitaxel and carboplatin (n = 444) or paclitaxel, carboplatin, and bevacizumab (n = 434). Chemotherapy was administered every 3 weeks for 6 cycles, and bevacizumab was administered every 3 weeks until disease progression was evident or toxic effects were intolerable.

Outcomes: Overall and progression-free survival.

Follow-up: Median, 19 months.

Results: Bevacizumab improved overall survival (median, 12.3 months vs. 10.3 months with chemotherapy alone; hazard ratio for death, 0.79 [CI, 0.67 to 0.92]; P = 0.003) and progression-free survival (median, 6.2 months vs. 4.5 months; hazard ratio for disease progression, 0.66; P < 0.001), and more patients in the bevacizumab group responded …

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