Another adjuvant Avastin letdown.

Adjuvant cisplatin-based chemo has been considered standard of care for resected early-stage non-small cell lung cancer (NSCLC) measuring over 4 cm since the 2009 reporting of non-significant, exploratory findings within the JBR.10 trial. This, coupled with the 2006 E4599 trial demonstrating an overall survival benefit with the addition of Avastin to standard carbo/taxol chemo in advanced NSCLC, led to the birth of the phase 3 E1505 trial published last week in Lancet. Patients with completely-resected NSCLC over 4 cm up to stage IIIA were randomized to +/- Avastin concurrent to dealer’s choice cisplatin-based doublet adjuvant chemo. The median survival for the Avastin arm was a little over 7 years, which was surpassed (and technically not reached) by the chemo alone arm. The best and most refreshing part to a pub that would otherwise be an all-out letdown is its simple and direct discussion: the authors unequivocally conclude there is no benefit to the addition of this costly drug that adds toxicity without adding longer life. We almost forgot how straightforward data interpretation can be without Big Pharma holding the pen.