ONCAlert | 2018 ASCO Annual Meeting
Lung Cancer Case Studies

Mark Socinski, MD: Antiangiogenic Therapy in NSCLC

Mark Socinski, MD
Published Online:Apr 28, 2016
RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month's duration. He is a former smoker and quit approximately 30 years ago.

mNSCLC with Mark Kris, MD and Mark Socinski, MD: Case 1



What clinical benefit do you achieve using an antiangiogenic therapy in this patient type that you don’t achieve with chemotherapy alone?

Adding antiangiogenic therapy in their first line setting, and this would be restricted really to bevacizumab, I think there are several benefits. First and foremost, what patients want almost universally is their tumor to shrink. We know that adding bevacizumab to chemotherapy, this has been consistent across 4 phase III trials done all over the world, increases overall response rates significantly. The other patients want is control of their cancer. In all of those 4 trials that I mentioned, there was an improvement in progression free survival that was statistically significant. I think in an age where we talk about not only statistical significant, but clinically meaningful benefit, I actually think that the overall response rate is very clinically meaningful. The progression free survival is a little less robust.

Patients want to live longer. In 2 of the 4 trials, we saw a survival advantage. Those were 2 trials that were designed to look at overall survival, so I think that's the third benefit that patients get. It comes at a risk. If we add bevacizumab to chemotherapy, we do increase the risk of certain side effects. The risk of neutropenia, the risk of febrile neutropenia, hypertension, effects on the kidney with proteinuria, you have to be concerned that there is a numerical increase in thrombotic events or aware of these sorts of things, and you have to be aware that you do expose the patient to more risk in choosing an antiangiogenic agent. If you're thoughtful in your patient selection, that antiangiogenic therapy has much more benefit than it has risk.

mNSCLC: Case 1

RP is a 72 year old whose past medical history is notable for hypertension (well-controlled), hyperuricemia, and gout. He presents to his PCP with fatigue, progressive dyspnea, and a persistent, nonproductive cough of approximately 1 month’s duration. He is a former smoker and quit approximately 30 years ago.

  • Chest X-ray in October 2015 showed a large mass in the upper left lobe and CT scan showed a left pleural effusion and enlargement of the left mediastinal and hilar lymph node.
  • MRI of the brain was negative for intracranial metastases.
  • The patient underwent resection of the primary mass which showed large cell carcinoma. Pleural fluid was tapped and also positive.
  • His lung cancer was staged as 4. His biopsy was sent for molecular testing and showed no actionable mutations in EGFR or ALK.
  • His current performance status is 1.
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