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Addition of Bevacizumab to Pembrolizumab in Platinum-Resistant Recurrent or Metastatic Nasopharyngeal Carcinoma


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In a Singaporean phase II trial reported in The Lancet Oncology, Chong et al found that the addition of bevacizumab to pembrolizumab improved objective response rate in patients with platinum-resistant recurrent or metastatic nasopharyngeal carcinoma.

Study Details

In the open-label trial, 48 patients from two sites in Singapore were randomly assigned between May 2019 and December 2023 to receive pembrolizumab at 200 mg every 21 days plus bevacizumab at 7.5 mg/kg 1 week prior to each pembrolizumab dose (n = 24) or pembrolizumab alone (n = 24) until radiographic disease progression, unacceptable toxicity, or completion of 32 cycles. The primary outcome measure was objective response rate on independent radiology review.  

Key Findings

Median follow-up was 28.3 months (interquartile range = 15.1–55.9 months). Objective responses were observed in 14 patients (58.3%, 95% confidence interval [CI] = 36.6%–77.9%) in the bevacizumab/pembrolizumab group vs 3 patients (12.5%, 95% CI = 2.7%–32.4%) in the pembrolizumab group (relative risk = 4.67, 95% CI = 1.54–14.18, P = .0010). Complete response was observed in one patient in each group. An additional 25% vs 21% of patients had stable disease. Median response duration was 16.4 months (95% CI = 11.7–29.5 months) with bevacizumab/pembrolizumab vs 8.8 months (95% CI = 7.1–22.6 months) with pembrolizumab. Median progression-free survival was 13.8 months (95% CI = 4.2–29.5 months) in the bevacizumab/pembrolizumab group vs 1.6 months (95% CI = 1.3–2.7 months) in the pembrolizumab group (hazard ratio = 0.25, 95% CI = 0.13–0.50, P < .0001).

Grade 3 treatment-related adverse events were observed in 29% of the bevacizumab/pembrolizumab group vs 8% of the pembrolizumab group; the most common adverse event in the bevacizumab/pembrolizumab group was thrombosis/bleeding (17%). No treatment-related grade 4 or 5 adverse events were reported.

The investigators concluded: “Pembrolizumab in combination with bevacizumab was more efficacious than pembrolizumab monotherapy, with manageable toxicities in platinum-resistant nasopharyngeal carcinoma. If validated in a phase III trial, the combination therapy could be a new standard of care in this population of patients.”

Boon-Cher Goh, MBBS, of the Cancer Science Institute of Singapore, National University of Singapore, is the corresponding author of The Lancet Oncology article.

Disclosure: The study was funded by the National Medical Research Council of Singapore, National Research Foundation Singapore, Merck Sharp & Dohme, and others.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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