BEAT-meso
A randomised phase III study of bevacizumab and carboplatin-pemetrexed chemotherapy with or without atezolizumab as first-line treatment for advanced pleural mesothelioma: results of the ETOP 13-18 BEAT-meso trial
Phase 3N = 400NCT03762018
- Population
- Patients with advanced diffuse pleural mesothelioma receiving first-line treatment
- Design
- International open-label 1:1 randomised phase 3 trial (ETOP 13-18), stratified by histology and stage: atezolizumab 1200 mg every 3 weeks until progression added to bevacizumab 15 mg/kg every 3 weeks until progression and 4 to 6 cycles of carboplatin with pemetrexed 500 mg/m2 every 3 weeks (ABC), versus bevacizumab plus the same chemotherapy (BC). 400 patients were randomised between 30 April 2019 and 7 March 2022, 200 per arm; 65% had ECOG performance status 1 and 78% had epithelioid histology. The primary endpoint was overall survival in all randomised patients, aiming for a hazard ratio of 0.708. The registry record lists an enrolment of 400.
- Primary endpoint
- OS
- Arms
- Bevacizumab plus carboplatin-pemetrexed (BC) (control, n = 200): Bevacizumab 15 mg/kg every 3 weeks until progression plus 4 to 6 cycles of carboplatin and pemetrexed 500 mg/m2 every 3 weeks
- Atezolizumab plus bevacizumab and chemotherapy (ABC) (experimental, n = 200): BC plus atezolizumab 1200 mg every 3 weeks until progression
- People
- Felip E
OSHR 0.84 (95% CI 0.66–1.06)Δ median OS+2.4 monthsPFSHR 0.72 (95% CI 0.59–0.89)Δ median PFS+1.6 monthsOSHR 0.51 (95% CI 0.32–0.80)OSHR 1.01 (95% CI 0.77–1.32)
Show the numbers
| Endpoint | Analysis | Atezolizumab plus bevacizumab and chemotherapy (ABC) | Bevacizumab plus carboplatin-pemetrexed (BC) | Effect |
|---|---|---|---|---|
| OSAll randomised patients | primarymedian follow-up 35 monthsFelip 2025 | median 20.5 months | median 18.1 months | HR 0.84 (95% CI 0.66–1.06)P=0.14Primary endpoint not met per the abstract. The abstract gives no confidence intervals for the medians. |
| PFSAll randomised patients | primarymedian follow-up 35 monthsFelip 2025 | median 9.2 months | median 7.6 months | HR 0.72 (95% CI 0.59–0.89)P=0.0021Secondary endpoint, analysed at the same cut-off as the primary analysis. |
| OSNon-epithelioid histology (analysis by histology that the abstract calls pre-specified) | exploratorymedian follow-up 35 monthsFelip 2025 | — | — | HR 0.51 (95% CI 0.32–0.80)Histology showed a significant treatment interaction for both OS and PFS (interaction P = 0.012, abstract). The abstract gives no medians or subgroup sizes. Hypothesis-generating because the primary endpoint was not met. |
| OSEpithelioid histology (analysis by histology that the abstract calls pre-specified) | exploratorymedian follow-up 35 monthsFelip 2025 | — | — | HR 1.01 (95% CI 0.77–1.32)Interaction P = 0.012 for histology (abstract). The abstract gives no medians or subgroup sizes. |
| Endpoint | Analysis | Atezolizumab plus bevacizumab and chemotherapy (ABC) | Bevacizumab plus carboplatin-pemetrexed (BC) | Effect |
|---|---|---|---|---|
| OSAll randomised patients | primarymedian follow-up 35 monthsFelip 2025 | median 20.5 months | median 18.1 months | HR 0.84 (95% CI 0.66–1.06)P=0.14Primary endpoint not met per the abstract. The abstract gives no confidence intervals for the medians. |
| PFSAll randomised patients | primarymedian follow-up 35 monthsFelip 2025 | median 9.2 months | median 7.6 months | HR 0.72 (95% CI 0.59–0.89)P=0.0021Secondary endpoint, analysed at the same cut-off as the primary analysis. |
| OSNon-epithelioid histology (analysis by histology that the abstract calls pre-specified) | exploratorymedian follow-up 35 monthsFelip 2025 | — | — | HR 0.51 (95% CI 0.32–0.80)Histology showed a significant treatment interaction for both OS and PFS (interaction P = 0.012, abstract). The abstract gives no medians or subgroup sizes. Hypothesis-generating because the primary endpoint was not met. |
| OSEpithelioid histology (analysis by histology that the abstract calls pre-specified) | exploratorymedian follow-up 35 monthsFelip 2025 | — | — | HR 1.01 (95% CI 0.77–1.32)Interaction P = 0.012 for histology (abstract). The abstract gives no medians or subgroup sizes. |
Data table
| Endpoint | HR | 95% CI |
|---|---|---|
| OS | 0.84 | 0.66–1.06 |
| PFS | 0.72 | 0.59–0.89 |
| OS | 0.51 | 0.32–0.8 |
| OS | 1.01 | 0.77–1.32 |
- Atezolizumab plus bevacizumab and chemotherapy (ABC) (experimental)
- Bevacizumab plus carboplatin-pemetrexed (BC) (control)
Median-only curves assume a constant hazard (exponential) and fit plateaus, as seen with some immunotherapies, poorly.
Data table (modelled values)
| Months | Atezolizumab plus bevacizumab and chemotherapy (ABC) | Bevacizumab plus carboplatin-pemetrexed (BC) |
|---|---|---|
| 0 | 100.0% | 100.0% |
| 13 | 64.4% | 60.8% |
| 26 | 41.5% | 36.9% |
| 38 | 27.7% | 23.3% |
| 51 | 17.8% | 14.2% |
- Atezolizumab plus bevacizumab and chemotherapy (ABC) (experimental)
- Bevacizumab plus carboplatin-pemetrexed (BC) (control)
Median-only curves assume a constant hazard (exponential) and fit plateaus, as seen with some immunotherapies, poorly.
Data table (modelled values)
| Months | Atezolizumab plus bevacizumab and chemotherapy (ABC) | Bevacizumab plus carboplatin-pemetrexed (BC) |
|---|---|---|
| 0 | 100.0% | 100.0% |
| 6 | 63.6% | 57.9% |
| 12 | 40.5% | 33.5% |
| 17 | 27.8% | 21.2% |
| 23 | 17.7% | 12.3% |
Appears in
Sources
Felip E, Popat S, Dafni U, Ribi K, Pope A, Cedres S, et al. A randomised phase III study of bevacizumab and carboplatin-pemetrexed chemotherapy with or without atezolizumab as first-line treatment for advanced pleural mesothelioma: results of the ETOP 13-18 BEAT-meso trial. Ann Oncol. 2025;36(5):548-560.