Stephen J Bagley1,2, Suzanna Talento3, Nandita Mitra4, Neal J Meropol5,6, Roger B Cohen1,2, Corey J Langer1,2, Anil Vachani1,7,8. 1. Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, and. 2. Abramson Cancer Center, Philadelphia, Pennsylvania. 3. Tufts University School of Medicine, Boston, Massachusetts. 4. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. 5. Flatiron Health, New York, New York. 6. Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio; and. 7. Division of Pulmonary, Allergy, and Critical Care, Perelman School of Medicine at the University of Pennsylvania, and. 8. Department of Medicine, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: 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). MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: In this large, real-world dataset, the addition of bevacizumab to first-line carboplatin/pemetrexed for metastatic nonsquamous NSCLC was associated with improved OS.
BACKGROUND: 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). MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSIONS: In this large, real-world dataset, the addition of bevacizumab to first-line carboplatin/pemetrexed for metastatic nonsquamous NSCLC was associated with improved OS.
Authors: Lee M Ellis; David S Bernstein; Emile E Voest; Jordan D Berlin; Daniel Sargent; Patricia Cortazar; Elizabeth Garrett-Mayer; Roy S Herbst; Rogerio C Lilenbaum; Camelia Sima; Alan P Venook; Mithat Gonen; Richard L Schilsky; Neal J Meropol; Lowell E Schnipper Journal: J Clin Oncol Date: 2014-03-17 Impact factor: 44.544
Authors: Fabrice Barlesi; Arnaud Scherpereel; Achim Rittmeyer; Antonio Pazzola; Neus Ferrer Tur; Joo-Hang Kim; Myung-Ju Ahn; Joachim G J V Aerts; Vera Gorbunova; Anders Vikström; Elaine K Wong; Pablo Perez-Moreno; Lada Mitchell; Harry J M Groen Journal: J Clin Oncol Date: 2013-07-08 Impact factor: 44.544
Authors: Alan Sandler; Robert Gray; Michael C Perry; Julie Brahmer; Joan H Schiller; Afshin Dowlati; Rogerio Lilenbaum; David H Johnson Journal: N Engl J Med Date: 2006-12-14 Impact factor: 91.245
Authors: Daniel M Gilden; Joanna M Kubisiak; Gerhardt M Pohl; Daniel E Ball; David E Gilden; William J John; Stewart Wetmore; Katherine B Winfree Journal: J Med Econ Date: 2016-09-14 Impact factor: 2.448
Authors: Giorgio Vittorio Scagliotti; Purvish Parikh; Joachim von Pawel; Bonne Biesma; Johan Vansteenkiste; Christian Manegold; Piotr Serwatowski; Ulrich Gatzemeier; Raghunadharao Digumarti; Mauro Zukin; Jin S Lee; Anders Mellemgaard; Keunchil Park; Shehkar Patil; Janusz Rolski; Tuncay Goksel; Filippo de Marinis; Lorinda Simms; Katherine P Sugarman; David Gandara Journal: J Clin Oncol Date: 2008-05-27 Impact factor: 44.544
Authors: Jyoti D Patel; Mark A Socinski; Edward B Garon; Craig H Reynolds; David R Spigel; Mark R Olsen; Robert C Hermann; Robert M Jotte; Thaddeus Beck; Donald A Richards; Susan C Guba; Jingyi Liu; Bente Frimodt-Moller; William J John; Coleman K Obasaju; Eduardo J Pennella; Philip Bonomi; Ramaswamy Govindan Journal: J Clin Oncol Date: 2013-10-21 Impact factor: 44.544