Bevacizumab fails to improve elderly NSCLC survival
MedWire News: Results indicate that the addition of bevacizumab to carboplatin and paclitaxel chemotherapy does not increase survival rates in older patients with non-small-cell lung cancer (NSCLC).
The bevacizumab-carboplatin-paclitaxel treatment regimen was approved in 2006 for advanced non-squamous-cell NSCLC. However, while previous clinical trials had shown improved survival rates for patients on this therapy, these effects were not duplicated in those aged 65 years and older.
As nearly two-thirds of patients with lung cancer are diagnosed after age 65, Deborah Schrag (Dana-Farber Cancer Institute, Boston, Massachusetts, USA) and colleagues studied whether adding bevacizumab to carboplatin plus paclitaxel improved survival rates in a Medicare population.
They reviewed data from the Surveillance, Epidemiology, and End Results database ‑ which covers about 28% of the US cancer patient population ‑ from 4168 Medicare patients with stage IIIB or IV NSCLC diagnosed between 2002 and 2007 who received first-line chemotherapy within 4 months of diagnosis with bevacizumab-carboplatin-paclitaxel or carboplatin plus paclitaxel.
The primary outcome was all-cause mortality. The median overall survival rate was 9.7 months for patients receiving the bevacizumab combination (n=318) compared with 8.9 months for those receiving carboplatin plus paclitaxel in 2006‑2007 (n=1184), and 8.0 months for those receiving carboplatin plus paclitaxel in 2002‑2005 (n=2666). Adjusted 1-year survival rates were similar between the treatment groups, at 39.6%, 40.1%, and 35.6%, respectively.
Based on their data, the investigators report that "none of the four propensity score-adjusted models demonstrated any evidence to support the superiority of bevacizumab-carboplatin-paclitaxel to carboplatin-paclitaxel."
They note that the lack of survival benefit seen with the addition of bevacizumab in their study is consistent with the lower survival rates in older patients found in other bevacizumab clinical trials.
The investigators therefore recommend that "clinicians should exercise caution in making treatment recommendations and should use bevacizumab judiciously for their older patients."
By Stephanie Leveene