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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.

Author information

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.

Abstract

INTRODUCTION:

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.

METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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

PMID:
24633407
PMCID:
PMC5083067
DOI:
10.1097/JTO.0000000000000127
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

There is no conflict of interest by any of the authors of this paper.

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