PURPOSE: Clinical trials have shown that adding bevacizumab to cytotoxic chemotherapy improves survival for patients with colorectal cancer, although its effectiveness in the Medicare population is uncertain. PATIENTS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) -Medicare linked database, we identified 2,526 patients with stage IV colorectal cancer diagnosed between 2002 and 2007 who received first-line combination chemotherapy with a fluoropyrimidine and either irinotecan (33%) or oxaliplatin (67%). Thirty-six percent of patients received bevacizumab with first-line therapy. The primary outcome was overall survival. Secondary outcomes were bevacizumab-associated toxicities, including the incidence of stroke, myocardial infarction, and GI perforation. RESULTS: In the primary cohort inclusive of patients diagnosed between 2002 and 2007, bevacizumab with combination chemotherapy was associated with improved overall survival (adjusted hazard ratio [HR], 0.85; 95% CI, 0.78 to 0.93), although the effect was more modest when restricted to years 2004 to 2007 (HR, 0.93; 95% CI, 0.84 to 1.02). The observed survival advantage of bevacizumab was more apparent with irinotecan-based chemotherapy (HR, 0.80; 95% CI, 0.66 to 0.97) than with oxaliplatin-based chemotherapy (HR, 0.96; 95% CI, 0.86 to 1.07). Combination chemotherapy with bevacizumab, versus combination chemotherapy without bevacizumab, was associated with increased risk of stroke (4.9% v 2.5%, respectively; P < .01) and GI perforation (2.3% v 1.0%, respectively; P < .01). Cardiac events and venous thrombosis were not increased with bevacizumab. CONCLUSION: The addition of bevacizumab to cytotoxic combination chemotherapy was associated with small improvement in overall survival as well as increased risk of stroke and perforation, but not cardiac events, among Medicare beneficiaries with stage IV colorectal cancer.
PURPOSE: Clinical trials have shown that adding bevacizumab to cytotoxic chemotherapy improves survival for patients with colorectal cancer, although its effectiveness in the Medicare population is uncertain. PATIENTS AND METHODS: Using the Surveillance, Epidemiology, and End Results (SEER) -Medicare linked database, we identified 2,526 patients with stage IV colorectal cancer diagnosed between 2002 and 2007 who received first-line combination chemotherapy with a fluoropyrimidine and either irinotecan (33%) or oxaliplatin (67%). Thirty-six percent of patients received bevacizumab with first-line therapy. The primary outcome was overall survival. Secondary outcomes were bevacizumab-associated toxicities, including the incidence of stroke, myocardial infarction, and GI perforation. RESULTS: In the primary cohort inclusive of patients diagnosed between 2002 and 2007, bevacizumab with combination chemotherapy was associated with improved overall survival (adjusted hazard ratio [HR], 0.85; 95% CI, 0.78 to 0.93), although the effect was more modest when restricted to years 2004 to 2007 (HR, 0.93; 95% CI, 0.84 to 1.02). The observed survival advantage of bevacizumab was more apparent with irinotecan-based chemotherapy (HR, 0.80; 95% CI, 0.66 to 0.97) than with oxaliplatin-based chemotherapy (HR, 0.96; 95% CI, 0.86 to 1.07). Combination chemotherapy with bevacizumab, versus combination chemotherapy without bevacizumab, was associated with increased risk of stroke (4.9% v 2.5%, respectively; P < .01) and GI perforation (2.3% v 1.0%, respectively; P < .01). Cardiac events and venous thrombosis were not increased with bevacizumab. CONCLUSION: The addition of bevacizumab to cytotoxic combination chemotherapy was associated with small improvement in overall survival as well as increased risk of stroke and perforation, but not cardiac events, among Medicare beneficiaries with stage IV colorectal cancer.
Authors: J Y Douillard; D Cunningham; A D Roth; M Navarro; R D James; P Karasek; P Jandik; T Iveson; J Carmichael; M Alakl; G Gruia; L Awad; P Rougier Journal: Lancet Date: 2000-03-25 Impact factor: 79.321
Authors: L B Saltz; J V Cox; C Blanke; L S Rosen; L Fehrenbacher; M J Moore; J A Maroun; S P Ackland; P K Locker; N Pirotta; G L Elfring; L L Miller Journal: N Engl J Med Date: 2000-09-28 Impact factor: 91.245
Authors: A de Gramont; A Figer; M Seymour; M Homerin; A Hmissi; J Cassidy; C Boni; H Cortes-Funes; A Cervantes; G Freyer; D Papamichael; N Le Bail; C Louvet; D Hendler; F de Braud; C Wilson; F Morvan; A Bonetti Journal: J Clin Oncol Date: 2000-08 Impact factor: 44.544
Authors: Richard M Goldberg; Daniel J Sargent; Roscoe F Morton; Charles S Fuchs; Ramesh K Ramanathan; Stephen K Williamson; Brian P Findlay; Henry C Pitot; Steven R Alberts Journal: J Clin Oncol Date: 2003-12-09 Impact factor: 44.544
Authors: Fairooz Kabbinavar; Herbert I Hurwitz; Louis Fehrenbacher; Neal J Meropol; William F Novotny; Grazyna Lieberman; Susan Griffing; Emily Bergsland Journal: J Clin Oncol Date: 2003-01-01 Impact factor: 44.544
Authors: Clemens Giessen; Ludwig Fischer von Weikersthal; Axel Hinke; Sebastian Stintzing; Frank Kullmann; Ursula Vehling-Kaiser; Julia Mayerle; Markus Bangerter; Claudio Denzlinger; Markus Sieber; Christian Teschendorf; Jens Freiberg-Richter; Christoph Schulz; Dominik Paul Modest; Nicolas Moosmann; Philipp Aubele; Volker Heinemann Journal: BMC Cancer Date: 2011-08-23 Impact factor: 4.430
Authors: Michael J Hassett; Hajime Uno; Angel M Cronin; Nikki M Carroll; Mark C Hornbrook; Paul Fishman; Debra P Ritzwoller Journal: Cancer Epidemiol Date: 2017-07-12 Impact factor: 2.984
Authors: Alex Z Fu; Huei-Ting Tsai; John L Marshall; Andrew N Freedman; Arnold L Potosky Journal: J Oncol Pharm Pract Date: 2013-10-11 Impact factor: 1.809
Authors: S Yousuf Zafar; Jennifer L Malin; Steven C Grambow; David H Abbott; Jane T Kolimaga; Leah L Zullig; Jane C Weeks; John Z Ayanian; Katherine L Kahn; Patricia A Ganz; Paul J Catalano; Dee W West; Dawn Provenzale Journal: Cancer Date: 2012-09-12 Impact factor: 6.860
Authors: Lauren A Dalvin; Matthew R Starr; Jackson E AbouChehade; Gena M Damento; Maria Garcia; Saumya M Shah; David O Hodge; Irene Meissner; Sophie J Bakri; Raymond Iezzi Journal: JAMA Ophthalmol Date: 2019-05-01 Impact factor: 7.389
Authors: H-T Tsai; J L Marshall; S R Weiss; C-Y Huang; J L Warren; A N Freedman; A Z Fu; L B Sansbury; A L Potosky Journal: Ann Oncol Date: 2013-02-20 Impact factor: 32.976
Authors: Veena Shankaran; David Mummy; Lisel Koepl; Aasthaa Bansal; Dana K Mirick; Elaine Yu; Rob Morlock; Sarika Ogale; Scott D Ramsey Journal: Oncologist Date: 2014-08-01