Patterns of prescribing radiotherapy and bevacizumab in nationwide practice – analysis of 101 designated cancer care hospitals in Japan

Abstract

Radiotherapy and bevacizumab are each effective in treating patients with advanced cancer, but their concurrent use may cause serious adverse events (SAEs). Whereas sequential administration can theoretically reduce the risk of SAEs while maintaining the anticancer effects, this hypothesis remains unconfirmed, leading to variations in practice. To elucidate current practices, the patterns of care received by patients in Japan with regard to these two therapies were assessed in a large database of a hospital-based cancer registry linked with insurance claims. This database contained information on 106 057 patients diagnosed with seven major cancers in 2011 and the care they received up to the end of 2012. In total, 335 patients from 101 hospitals in the database were treated with both radiotherapy and bevacizumab. Of these patients, 50.8% had lung cancer, and 51.3% had Stage IV cancer. Of the 335 patients, 75 (22.4%) received these therapies concurrently. In patients treated sequentially, the time from the last dose of bevacizumab to the start of radiotherapy was most frequently 4–5 weeks (12.4%), whereas the time from the end of radiotherapy to the start of bevacizumab was most frequently 1–2 weeks (10.6%). The cumulative proportions of patients in these two groups receiving sequential therapies within 3 weeks were 19.0% and 26.1%, respectively. Many practices appeared to avoid the concurrent use of bevacizumab and radiation, but some provided concurrent therapy. Additional data are required to determine whether the avoidance of concurrent use should become a standard of care.

Combination of Palliative Thoracic Radiotherapy With Bevacizumab for Stage IV Nonsquamous NSCLC: Is There Any Impact of Time Interval on Survival?

“… 12 Patients received bevacizumab (7.5 mg/kg) before or after undergoing thoracic radiotherapy. 13 , 14 This was combined with paclitaxel + carboplatin or pemetrexed + carboplatin or docetaxel. The time interval between thoracic radiotherapy and bevacizumab administration was defined as the time between the last dose of thoracic radiotherapy and the first dose of bevacizumab (R-B group) or vice versa (B-R group).…”

Re-evaluating the risk factors for radiation pneumonitis in the era of immunotherapy

“…RP, tracheoesophageal fistula and haemoptysis incidence exceeded the clinically acceptable range. Many clinical trials were interrupted due to the high severity and incidence of adverse reactions; therefore, the two drugs should not be used together [68][69][70][71].…”

The incidence of and risk factors for radiation pneumonitis in patients treated with simultaneous bevacizumab and thoracic radiotherapy

“…However, the risk factors for RP in patients treated with simultaneous bevacizumab and TRT have always been a concern for clinical doctors [ 16 , 17 ]. Six patients receiving radiotherapy combined with bevacizumab were included in a small phase I clinical trial.…”