Single-institution experience with pemetrexed and bevacizumab as salvage therapy in advanced non-small-cell lung cancer

BACKGROUND: Second-line cytotoxic therapy for patients with advanced non-small-cell lung cancer (NSCLC) includes single-agent pemetrexed or docetaxel. The addition of bevacizumab to carboplatin/paclitaxel in the first-line setting was shown to improve survival and response. We assessed pemetrexed and bevacizumab compared with pemetrexed alone in the salvage setting. PATIENTS AND METHODS: Patients with advanced NSCLC, in whom at least first-line therapy failed and who received pemetrexed alone or pemetrexed/bevacizumab, were analyzed. RESULTS: From March 2005 through March 2006, we identified 25 patients treated with pemetrexed or pemetrexed/bevacizumab in the salvage setting. There were no significant differences in clinical features. All 25 were evaluable for overall survival, 21 for time to progression, and 19 for objective response evaluation. After a median follow-up of 9.3 months, there were no differences between the cohorts for median overall survival, time to progression, or objective disease control rate (partial response and stable disease). The 6-month survival rate was 56.3% for the pemetrexed group and 66.7% for the pemetrexed/bevacizumab group. There were no grade 3-5 hemorrhagic events. CONCLUSION: This retrospective single institution analysis showed that pemetrexed/bevacizumab was safely administered in the salvage setting of advanced NSCLC. Whether bevacizumab enhances the efficacy of pemetrexed remains to be determined and is the subject of an ongoing randomized clinical trial. Until those results are reported, off-label use of pemetrexed and bevacizumab is not recommended.