Comparative Effectiveness of Adjunctive Bevacizumab for Advanced Lung Cancer: The Cancer Research Network Experience

Abstract

Introduction Bevacizumab plus carboplatin-paclitaxel (BCP) chemotherapy has FDA approval for advanced non-squamous, non-small cell lung cancer (NS-NSCLC) based upon improved survival in a clinical trial. However, sub-group analyses of this and other studies have suggested variable results by age and gender. Methods 1,605 HMO NS-NSCLC patients aged ≥ 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 post-diagnosis: 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. Multi-variable sub-analyses were also estimated. Results Median survival was 12.3 months (inter quartile 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% CI 0.66–0.94) and 0.63 (95% CI 0.52–0.75) respectively. In the multivariable-adjusted sub-analyses, relative to the CP2005 cohort, the BCP hazard ratios for patients age <65 years, age ≥65 years, 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 to CP.

Medical Care Costs for Recurrent versus De Novo Stage IV Cancer by Age at Diagnosis

“…Consistent with our previous studies related to treatments and outcomes for patients with advanced cancer (Ritzwoller et al. , ), we strongly believe that our findings generalize to other settings. However, given that financial incentives to provide more expensive treatments are mitigated within the KP setting, the cost estimates from this study may actually be less than what one might observe in a fee‐for‐service setting.…”

“…VTR and VDW data are linked through a common, unique patient identifier (Ritzwoller et al. , , ; Hassett et al. ).…”

“…Oral and infused chemotherapy and immunotherapy were captured in the VDW infusion, pharmacy, and procedure files using methods previously described (Ritzwoller et al. , ; Carroll et al. ).…”

The Cancer Research Network: a platform for epidemiologic and health services research on cancer prevention, care, and outcomes in large, stable populations

“…The VDW includes tables that capture information on demographics of health plan enrollees and/or health system patients, health plan enrollment, health care encounters, diagnoses, procedures, pharmacy fills, vital signs, social history, vital status, and laboratory values. Within the VDW, the tumor table (also known as the Virtual Tumor Registry [VTR]) contains data consistent with the North American Association of Central Cancer Registries standards (www.naaccr.org/)[13]. Tumor data are obtained from manual review of cancer patients’ medical records by trained medical record abstractors.…”

Effect of angiotensin system inhibitors on survival in patients receiving chemotherapy for advanced non-small cell lung cancer.

“…Eligible patients receiving first-line CP or CPB were identified using the VDW Pharmacy, Procedure, and Infusion datasets with methods described previously. 14,[18][19][20] First-line chemotherapy initiation was defined as the date of the first chemotherapy regimen initiated after cancer diagnosis. Figure 1 shows the selection of patients with NSCLC from which the study cohort was derived.…”