We thank Hanna et al¹ and Xie et al² for their comments on our recent publication of the ECOG-ACRIN 5508 maintenance therapy trial.³ Hanna and Jalal contend that the combination of bevacizumab and pemetrexed should be considered for clinical use under selected circumstances on the basis of consistent improvement in progression-free survival data observed across trials. They also accurately point out that not a single trial has demonstrated significant improvement in overall survival with the combination regimen. In fact, the results of ECOG-ACRIN 5508 are consistent with observations from other trials. The hazard ratio for overall survival was 0.9 in this trial. The AVAPERL⁴ and COMPASS⁵ studies mentioned by the authors reported hazard ratios for overall survival of 0.87 in each. Our article about ECOG-ACRIN 5508 had been accepted for publication by the Journal of Clinical Oncology before the presentation of the results of the COMPASS study; hence, we did not have the opportunity to cite those results. The fact that all of the trials demonstrate a modest numerical improvement in survival for the combination regimen without a statistically significant overall survival benefit cannot be accepted as sufficient grounds to recommend this strategy.

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答复N. Hanna等人和L. Xie等人。

我们感谢Hanna等人¹和Xie等人²对我们最近发表的ECOG-ACRIN 5508维持疗法试验的评论。³ Hanna和Jalal认为，应根据在整个试验中观察到的无进展生存数据的持续改善，在特定情况下考虑将贝伐单抗和培美曲塞的组合用于临床。他们还准确地指出，没有一项试验显示联合疗法可显着改善总体生存率。实际上，ECOG-ACRIN 5508的结果与其他试验的观察结果一致。在该试验中，总生存风险比为0.9。AVAPERL ⁴和COMPASS ⁵作者提到的研究报告说，每一种的总生存风险比为0.87。在介绍COMPASS研究结果之前，我们关于ECOG-ACRIN 5508的文章已被《临床肿瘤学杂志》发表。因此，我们没有机会引用这些结果。所有试验均表明联合治疗的生存率在数值上有所改善，而没有统计学上显着的总体生存获益，这一事实不能被视为推荐该策略的充分依据。