Rituximab With or Without Bevacizumab for the Treatment of Patients With Relapsed Follicular Lymphoma

Inhibition of angiogenesis by interrupting the vascular endothelial growth factor (VEGF) pathway is therapeutically valuable in several solid tumors. Here, we compared the efficacy and toxicity of rituximab with bevacizumab versus single-agent rituximab, in patients with previously treated follicular lymphoma. The addition of bevacizumab to rituximab significantly improved progression-free survival (PFS). The role of angiogenesis inhibition in follicular lymphoma treatment requires further definition in larger clinical trials. Introduction/Background: Inhibition of tumor angiogenesis by the interruption of VEGF pathway signaling is of therapeutic value in several solid tumors. Preclinical evidence supports similar importance of the pathway in non-Hodgkin lymphoma. In this randomized phase II trial, we compared the efficacy and toxicity of rituximab with bevacizumab versus single-agent rituximab, in patients with previously-treated follicular lymphoma. Patients and Methods: Patients (n = 60) were randomized (1:1) to receive rituximab (375 mg/m(2) intravenously [I.V.] weekly for 4 weeks) either as a single agent or with bevacizumab (10 mg/kg I.V. on days 3 and 15). Patients with an objective response or stable disease at week 12 received 4 additional doses of rituximab (at months 3, 5, 7, and 9); patients who received rituximab/bevacizumab also received bevacizumab 10 mg/kg I.V. every 2 weeks for 16 doses. Results: After a median follow-up of 34 months, PFS was improved in patients who received rituximab/bevacizumab compared with patients who received rituximab alone (median 20.7 vs. 10.4 months respectively; HR, 0.40(95% confidence interval [Cl], 0.20-0.80); P = .007). Overall survival was also improved numerically (73% vs. 53% at 4 years), but did not reach statistical significance (HR, 0.40 (95% Cl, 0.15-1.05); P = .055). The addition of bevacizumab increased the toxicity of therapy, but both regimens were well tolerated (no grade 4 toxicity). Conclusion: The addition of bevacizumab to rituximab significantly improved PFS. The role of angiogenesis inhibition in the treatment of follicular lymphoma requires further definition in larger clinical trials.