Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial

RCT (n=448) found that addition of bevacizumab (vs. placebo) to pemetrexed plus cisplatin significantly improved overall survival in malignant pleural mesothelioma (median 18.8 vs. 16.1 months; HR 0.77; 0.62–0.95; p=0.0167), at the cost of expected manageable toxic effects.

According to a commentary, despite the impressive results of this rigorously designed and executed phase 3 clinical trial, many questions remain, for which definitive answers will probably never be obtained:

 

• For patients who cannot tolerate cisplatin, should bevacizumab be added to carboplatin and pemetrexed?

 

• What about patients older than 75 years of age who were excluded from study? Where does pemetrexed maintenance fit into this paradigm?

 

• In view of the previous negative trial of bevacizumab added to cisplatin and gemcitabine, are these results specific to the combination of pemetrexed and bevacizumab?