Interpreting the Results of the AVAPERL Trial

Heather Wakelee, MD, an assistant professor at the Stanford University School of Medicine and member of the Stanford Cancer Institute, discusses the results of the AVAPERL trial.

In the AVAPERL trial, patients with non-small cell lung cancer were treated with cisplatin, pemetrexed, and bevacizumab, Wakelee says. The non-progressing patients were then randomly selected to either stay on bevacizumab alone or receive pemetrexed and bevacizumab.

Wakelee says the trial showed a striking improvement of progression-free survival for the patients who received both pemetrexed and bevacizumab. In the final overall survival analysis, there was a numeric advantage to the two-drug regimen, Wakelee says, but it was not statistically significant.

Wakelee interprets the data to mean that the two-drug regimen is more active, but she questions if the increased toxicity is worth it for every patient.

Clinical Pearls

• In the AVAPERL trial, patients with NSCLC were treated with cisplatin, pemetrexed, and bevacizumab. The non-progressing patients were then randomly selected to stay on bevacizumab alone or receive pemetrexed and bevacizumab
• The data showed an improvement of PFS for patients who received both pemetrexed and bevacizumab, but the final overall analysis was not statistically significant
• While the two-drug regimen is more active, it comes with increased toxicity and its use merits an individual patient discussion