Title: Comparative Effectiveness of Carboplatin/Pemetrexed With Versus Without Bevacizumab for Advanced Nonsquamous Non-Small Cell Lung Cancer.
Authors: Bagley, Stephen J; Talento, Suzanna; Mitra, Nandita; Meropol, Neal J; Cohen, Roger B; Langer, Corey J; Vachani, Anil
Published In J Natl Compr Canc Netw, (2019 05 01)
Abstract: Despite recent advances in targeted therapy and immunotherapy for advanced non-small cell lung cancer (NSCLC), carboplatin/pemetrexed/bevacizumab remains a commonly used first-line regimen. However, it is unknown whether the addition of bevacizumab to carboplatin/pemetrexed improves overall survival (OS).Using nationally representative curated electronic health record data from Flatiron Health, we performed a retrospective cohort study of patients diagnosed with advanced nonsquamous NSCLC who received ≥1 cycle of carboplatin/pemetrexed ± bevacizumab as initial systemic therapy for stage IV or metastatic/recurrent disease. The OS impact of adding bevacizumab to carboplatin/pemetrexed was assessed using a Cox proportional hazards model to adjust for age, sex, race, original tumor stage, time between diagnosis of metastatic disease and start of chemotherapy, and performance status. In a secondary analysis of patients at a single academic institution, we also adjusted for the presence of brain metastases, hemoptysis, and anticoagulation.A total of 4,724 patients were included, of which 2,759 patients (58%) received carboplatin/pemetrexed and 1,965 (42%) received carboplatin/pemetrexed/bevacizumab. Median OS was 12.1 months (95% CI, 11.2-12.9 months) in the carboplatin/pemetrexed/bevacizumab group compared with 8.6 months (95% CI, 8.1-9.1 months) in the carboplatin/pemetrexed group (P<.001). Bevacizumab use remained associated with improved OS in a multivariate model (hazard ratio, 0.80; 95% CI, 0.75-0.86; P<.001). In the secondary, institutional analysis (N=539), the effect of bevacizumab was unchanged (hazard ratio, 0.75; 95% CI, 0.59-0.96; P=.02).In this large, real-world dataset, the addition of bevacizumab to first-line carboplatin/pemetrexed for metastatic nonsquamous NSCLC was associated with improved OS.
PubMed ID: 31085759
MeSH Terms: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols/adverse effects; Antineoplastic Combined Chemotherapy Protocols/therapeutic use*; Bevacizumab/administration & dosage; Carboplatin/administration & dosage; Carcinoma, Non-Small-Cell Lung/drug therapy*; Carcinoma, Non-Small-Cell Lung/mortality; Carcinoma, Non-Small-Cell Lung/pathology*; Drug Administration Schedule; Female; Humans; Kaplan-Meier Estimate; Lung Neoplasms/drug therapy*; Lung Neoplasms/mortality; Lung Neoplasms/pathology*; Male; Middle Aged; Neoplasm Staging; Pemetrexed/administration & dosage; Prognosis; Proportional Hazards Models; Treatment Outcome