The impact of prior exposure to adjuvant chemotherapy on selection of front-line therapy for metastatic disease is a common theme across much of solid tumor oncology. Therefore, we asked how clinicians would care for a patient with high tumor burden, symptomatic, pan-wild-type adenocarcinoma with no contraindications to bevacizumab 12 months after completing one of the most common current adjuvant regimens, cisplatin and pemetrexed. As might be expected, most oncologists, in addition to the faculty, avoid rechallenging with pemetrexed and instead opt for the “4599” ECOG regimen of paclitaxel, carboplatin and bevacizumab.

Sandler A et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med 2006;355(24):2542-50. Abstract

Patel JD et al. PointBreak: A randomized phase III study of pemetrexed plus carboplatin and bevacizumab followed by maintenance pemetrexed and bevacizumab versus paclitaxel plus carboplatin and bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small-cell lung cancer. J Clin Oncol 2013;31(34):4349-57. Abstract