Cisplatin/pemetrexed followed by maintenance pemetrexed versus carboplatin/paclitaxel/bevacizumab followed by maintenance bevacizumab in advanced nonsquamous lung cancer: The GOIM (Gruppo Oncologico Italia Meridionale) ERACLE phase III randomized trial

Domenico Galetta, Saverio Cinieri, Salvatore Pisconti, Vittorio Gebbia, Alessandro Morabito, Nicola Borsellino, Evaristo Maiello, Antonio Febbraro, Annamaria Catino, Pietro Rizzo, Michele Montrone, Andrea Misino, Antonio Logroscino, Daniele Rizzi, Massimo Di Maio, Giuseppe Colucci

Research output: Contribution to journalArticle


Introduction Cisplatin with pemetrexed (CP) and carboplatin with paclitaxel and bevacizumab (CbTB) are standard first-line treatments for patients with advanced nonsquamous (NS) non-small-cell lung cancer (NSCLC). Quality of life (QoL) is a key objective in the management of advanced NSCLC. Thus, effect on QoL could be an additional factor in the choice of treatment. Patients and Methods Patients with untreated stage IIIB/IV NS-NSCLC and Eastern Cooperative Oncology Group performance status of 0 or 1 were randomized to receive first-line chemotherapy with cisplatin 75 mg/m2 and pemetrexed 500 mg/m2, every 3 weeks, for 6 cycles followed by maintenance pemetrexed; or carboplatin area under the curve 6, paclitaxel 200 mg/m2, and bevacizumab 15 mg/kg, every 3 weeks, for 6 cycles followed by maintenance bevacizumab. The primary end point was the difference in QoL between the 2 treatment arms after 12 weeks of maintenance, measured using the EuroQoL 5 Dimensions-Index (EQ5D-I) and EQ5D-visual analogue scale (EQ5D-VAS). Results One hundred eighteen patients were randomized to CP (n = 60) or CbTB (n = 58). Baseline characteristics were well balanced. The proportion of patients evaluable for the primary end point was lower than planned. After 12 weeks of maintenance, the difference between mean changes in EQ5D-I was 0.137, favoring CP (95% confidence interval [CI], -0.02 to 0.29, Wilcoxon P =.078), although not statistically significant; and the difference between mean changes in EQ5D-VAS was 0.97 (95% CI, -9.37 to 11.31, Wilcoxon P =.41). Conclusion Although the study was underpowered because of a small number of patients evaluable for the primary end point, QoL did not differ between treatment arms. Other factors such as comorbidities and schedule should be used when deciding on first-line treatment.

Original languageEnglish
Pages (from-to)262-273
Number of pages12
JournalClinical Lung Cancer
Issue number4
Publication statusPublished - Jul 1 2015



  • Advanced NSCLC
  • EQ5D
  • Quality of life
  • Symptom palliation
  • Treatment choice

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pulmonary and Respiratory Medicine

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