For the first-line treatment of metastatic lung adenocarcinoma without a targetable driver mutation, do you routinely add bevacizumab to the chemotherapy backbone in the absence of a contraindication to the drug?

That is a really good question. In my practice, I typically will use carboplatin plus pemetrexed for 4-6 cycles followed by maintenance pemetrexed. The addition of bevacizumab consistently improves response rates when added to chemotherapy, so if I have a patient that is symptomatic from local disease (pain, obstructing tumor, high volume disease), then I will add bevacizumab. As you know, there is evidence that bevacizumab improves RR, PFS, and OS when combined with carboplatin and paclitaxel. Bevacizumab improves RR and PFS, but not OS when added to cisplatin plus gemcitabine. There are no trials that evaluate carboplatin plus pemetrexed plus or minus bevacizumab, so it is unkown whether the addition of bevacizumab to carboplatin and peme...

I agree with the above and would also add consideration for the phase II BRAIN study showing the utility of bevacizumab in the front line for patients with brain metastases.