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J Thorac Oncol. 2014 May;9(5):692-701. doi: 10.1097/JTO.0000000000000127.

Comparative effectiveness of adjunctive bevacizumab for advanced lung cancer: the cancer research network experience.

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  • 1*The Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; †The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; ‡Division of Research, Kaiser Permanente Northern California, Oakland, California; §The Group Health Research Institute, Seattle, Washington; ‖Fred Hutchinson Cancer Research Center, Seattle, Washington; and ¶Department of Oncology, Kaiser Permanente Colorado, Denver, Colorado.



Bevacizumab plus carboplatin-paclitaxel (BCP) chemotherapy has Food and Drug Administration approval for advanced nonsquamous, non-small-cell lung cancer based upon improved survival in a clinical trial. However, subgroup analyses of this and other studies have suggested variable results by age and gender.


Using data from four health maintenance organizations (HMOs) belonging to the Cancer Research Network, 1605 HMO nonsquamous, non-small-cell lung cancer patients aged younger than 21 years, diagnosed 2002-2010, who received carboplatin-paclitaxel (CP), with and without bevacizumab for first-line treatment of stage IIIB/IV disease were identified. Patients were categorized into three groups based on year of diagnosis and regimen during 120 days postdiagnosis: (1) diagnosed 2005-2010 and received BCP; (2) 2005-2010, CP (CP2005), and (3) 2002-2004, CP (CP2002). Survival differences between groups were estimated using Cox proportional hazard models with several propensity score adjustments for demographic, comorbidity, and tumor characteristics. Multivariable subanalyses were also estimated.


Median survival was 12.3 months (interquartile range [IQR], 6.0-29.1) for BCP patients versus 8.8 months (IQR, 3.7-21.3) for CP2005 patients and 7.5 months (IQR, 3.8-15.6) for CP2002 patients. In the propensity score-adjusted models, BCP demonstrated a significant survival benefit with a hazard ratio of BCP relative to CP2005 and CP2002 patients of 0.79 (95% confidence interval [CI], 0.66-0.94) and 0.63 (95% CI, 0.52-0.75), respectively. In the multivariable-adjusted subanalyses, relative to the CP2005 cohort, the BCP hazard ratios for patients age less than 65 years, age 65 years old or older, and females were 0.78 (95% CI, 0.62-1.00), 0.74 (95% CI, 0.54-1.00), and 0.77 (95% CI, 0.58-1.00).


In this community-based, comparative effectiveness analysis, we found an overall survival benefit for adults receiving BCP compared with CP.

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