Linifanib in stage IIIB or IV non-small cell lung cancer

Platinum-based chemotherapy is standard treatment for non-small cell lung cancer (NSCLC), but in the expanding world of tyrosine kinase inhibitors established regimes are being questioned. Ramalingham et al (J Clin Oncol 2015;33:433–41) have published a Phase II randomised, double-blind, placebo-controlled multicentre trial studying the effect of adding linifanib to carboplatin and paclitaxel. Patients with stage IIIB or IV NSCLC and performance status 1 or below were carefully selected and then randomised to three arms: carboplatin and paclitaxel plus placebo, 7.5 mg linifanib or 12.5 mg linifanib. Progression-free survival (PFS) was significantly improved in the linifanib 7.5 mg arm compared with the 12.5 mg and placebo arms (252, 221 and 174 days, respectively). Overall survival was not different between the arms, although the study was underpowered for this outcome. There was a significant improvement of PFS in the linifanib arms in a subgroup of patients with a positive CEA/CYFRA 21-1 biomarker signature. Adverse events were higher in the linifanib arms, including thrombocytopenia and two deaths, as well as dose-related diarrhoea, …