Keep, keep bleeding love.

Top Line: Does bevacizumab improve outcomes for recurrent/metastatic head and neck squamous cell carcinoma (HNSCC)?

The Study: Wait, isn’t chemo plus pembro the preferred regimen in this setting? Let’s reflect. The backbone of treatment for recurrent or metastatic HNSCC is platinum-based chemo. In 2008, Merck showed that adding cetuximab to platinum/5FU improved survival in this population. A decade later, Merck outdid themselves with results of KEYNOTE-048 reporting the addition of pembro to platinum/5FU incrementally improved survival over cetuximab + platinum/5FU. And in patients with high PDL-1 expression, pembro alone improved survival over cetuximab + platinum/5FU. But wait, here we have final results from the ECOG E1305 trial where patients with recurrent or metastatic HNSCC received platinum-based chemo +/- bevacizumab. Huh? Yea, E1305’s timing was unfortunate and includes no comparison with either cetuximab or pembro. Which wasn’t all bad considering there was no significant improvement in overall survival with bev (13 months) compared to just chemo alone (11 months). There was, however, a significant increase in major bleeding events and death, probably washing out any potential oncologic advantage.

TBL: Despite good intentions, bevacizumab added to platinum/5FU significantly increases toxicity without improving survival in patients with recurrent/metastatic HNSCC. | Argiris, J Clin Oncol 2019