CancerNetwork provides a video highlighting Winship Cancer Institute, Emory University investigator Suresh S. Ramalingam, MD about the results of the ECOG-ACRIN 558 trial.  The study focused on pemetrexed, bevacizumab, or a combination of both as maintenance therapy for advanced non-squamous NSCLC which were presented at ASCO 2019.

ECOG-ACRIN 5508 Trial

The study was a randomized phase III trial assessing bevacizumab and pemetrexed disodium alone or in combination after induction therapy to see how well they work in treating patients with advanced non-squamous non-small cell lung cancer.

The study sponsors planned for 1282 patients at up to 434 study locations.  The start date was 2010 and final end date planned in 2020.

Rational for Study

Drugs used in chemotherapy, such as paclitaxel or carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways.  Some block the ability of tumor cells to grow and spread. Others find tumor cells and help them kill them or carry tumor-killing substances to them.  Bevacizumab may also stop the growth of non-small cell lung cancer by blocking blood flow to the tumor. Pemetrexed disodium may stop the growth of tumor cells by blocking some enzymes needed for cell growth. It is not yet known whether giving bevacizumab or pemetrexed disodium alone or in combination is more effective in treating non-squamous non-small cell lung cancer.


We enrolled 1516 pts to step 1 (male 52%; ECOG PS 1 62%; adenocarcinoma 90%); After induction therapy, 874 (57%) pts were randomized to step 2 (median age 64 yrs; male 49%; ECOG PS 1 55%). Baseline characteristics were balanced across all three groups. The median follow-up in maintenance is 50.6 months.


Single agent bevacizumab or pemetrexed is the optimal maintenance therapy for advanced non-squamous NSCLC. The combination of bevacizumab and pemetrexed cannot be recommended due to the lack of survival benefit in this definitive study. (Drs. Ramalingam, Dahlberg and Belani contributed equally to this work). Supported by the NCI: CA180820, CA180794,CA180799, CA180821, CA180838, CA180844, CA180847, CA180853, CA180857, CA180864, CA180867, CA180868, CA180870, CA180882, CA189830, CA189859, CA189863, CA189971. Clinical trial information


Eastern Cooperative Oncology Group 

National Cancer Institute  (NCI) 

Lead Research/Investigator

Suresh Ramalingam, MD 

Source: Cancer Network

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