http://jama.ama-assn.org/content/307/15/1593.abstract
Context A previous randomized trial
demonstrated that adding bevacizumab to carboplatin and paclitaxel
improved survival in advanced
non–small cell lung cancer (NSCLC). However, longer
survival was not observed in the subgroup of patients aged 65 years or
older.
Objective To examine whether adding bevacizumab to carboplatin and paclitaxel chemotherapy is associated with improved survival in
older patients with NSCLC.
Design, Setting, and Participants
Retrospective cohort study of 4168 Medicare beneficiaries aged 65 years
or older with stage IIIB or stage IV non−squamous
cell NSCLC diagnosed in 2002-2007 in a
Surveillance, Epidemiology, and End Results (SEER) region. Patients were
categorized
into 3 cohorts based on diagnosis year and type of
initial chemotherapy administered within 4 months of diagnosis: (1)
diagnosis
in 2006-2007 and bevacizumab-carboplatin-paclitaxel
therapy; (2) diagnosis in 2006-2007 and carboplatin-paclitaxel therapy;
or (3) diagnosis in 2002-2005 and
carboplatin-paclitaxel therapy. The associations between
carboplatin-paclitaxel with vs
without bevacizumab and overall survival were
compared using Cox proportional hazards models and propensity score
analyses
including information about patient characteristics
recorded in SEER-Medicare.
Main Outcome Measure Overall survival measured from the first date of chemotherapy treatment until death or the censoring date of December 31,
2009.
Results The median
survival estimates were 9.7 (interquartile range [IQR], 4.4-18.6) months
for bevacizumab-carboplatin-paclitaxel,
8.9 (IQR, 3.5-19.3) months for
carboplatin-paclitaxel in 2006-2007, and 8.0 (IQR, 3.7-17.2) months for
carboplatin-paclitaxel
in 2002-2005. One-year survival probabilities were
39.6% (95% CI, 34.6%-45.4%) for bevacizumab-carboplatin-paclitaxel vs
40.1%
(95% CI, 37.4%-43.0%) for carboplatin-paclitaxel in
2006-2007 and 35.6% (95% CI, 33.8%-37.5%) for carboplatin-paclitaxel in
2002-2005. Neither multivariable nor propensity
score–adjusted Cox models demonstrated a survival advantage for
bevacizumab-carboplatin-paclitaxel
compared with carboplatin-paclitaxel cohorts. In
propensity score–stratified models, the hazard ratio for overall
survival
for bevacizumab-carboplatin-paclitaxel compared
with carboplatin-paclitaxel in 2006-2007 was 1.01 (95% CI, 0.89-1.16; P = .85) and compared with carboplatin-paclitaxel in 2002-2005 was 0.93 (95% CI, 0.83-1.06; P = .28).
The propensity score–weighted model and propensity score–matching model
similarly failed to demonstrate a statistically
significant superiority for
bevacizumab-carboplatin-paclitaxel. Subgroup and sensitivity analyses
for key variables did not
change these findings.
