Commentary on Bevacizumab plus interferonα compared with interferonα monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206: Rini BI, Halabi S, Rosenberg JE, Stadler WM, Vaena DA, Ou SS, Archer L, Atkins JN, Picus J, Czaykowski P, Dutch

Bevacizumab is an antibody that binds to vascular endothelial growth factor (VEGF) and has activity in metastatic renal cell carcinoma (RCC). Interferonα (IFN) is a historic standard first-line treatment for RCC. A prospective, randomized phase III trial of bevacizumab plus IFN vs. IFN monotherapy was conducted. ts with previously untreated, metastatic clear-cell RCC were randomly assigned to receive either bevacizumab (10 mg/kg intravenously every 2 weeks) plus IFN (9 million U subcutaneously 3 times weekly) or the same dose and schedule of IFN monotherapy in a multicenter phase III trial. The primary end point was overall survival (OS). Secondary end points were progression-free survival (PFS), objective response rate (ORR), and safety. n October 2003 and July 2005, 732 patients were enrolled. The prespecified stopping rule for OS has not yet been reached. The median PFS was 8.5 months in patients receiving bevacizumab plus IFN (95% CI, 7.5–9.7 months) vs. 5.2 months (95% CI, 3.1–5.6 months) in patients receiving IFN monotherapy (log-rank P < 0.0001). The adjusted hazard ratio was 0.71 (95% CI, 0.61–0.83; P < 0.0001). Bevacizumab plus IFN had a higher ORR as compared with IFN (25.5% [95% CI, 20.9%–30.6%] vs. 13.1% [95% CI, 9.5%–17.3%]; P < 0.0001). Overall toxicity was greater for bevacizumab plus IFN, including significantly more grade 3 hypertension (9% vs. 0%), anorexia (17% vs. 8%), fatigue (35% vs. 28%), and proteinuria (13% vs. 0%). zumab plus IFN produces a superior PFS and ORR in untreated patients with metastatic RCC compared with IFN monotherapy. Toxicity is greater in the combination therapy arm.