The Use, Effectiveness, and Safety of Bevacizumab In Older Adults With Advanced Stage Non-Small Cell Lung Cancer Public Deposited

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  • March 22, 2019
Creator
  • Katz, Aaron Jacob
    • Affiliation: Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy
Abstract
  • Background: In clinical trials, the addition of bevacizumab to standard platinum-based doublet chemotherapy significantly improved overall survival in patients with advanced non-small cell lung cancer (NSCLC). However, a significant survival advantage with bevacizumab was not detected in subsequent analyses of patients aged 65 years and older. Objectives: To identify patient and health system characteristics associated with the use of bevacizumab and evaluate its effectiveness and safety in older patients with advanced NSCLC. Methods: Retrospective cohort study of adults 66 years or older identified within the Surveillance, Epidemiology, and End Results (SEER)-Medicare database with a diagnosis of stage IIIB or stage IV non-squamous NSCLC between 2004 and 2007. Descriptive statistics were used to characterize the utilization of bevacizumab. Multivariable logistic regression models were run to estimate the odds of bevacizumab use based on patient demographic, clinical, and health system characteristics. Logistic regression and Cox proportional hazards models were used to evaluate the effect of adding bevacizumab to platinum-based doublet chemotherapy on overall survival and hospitalization for severe treatment-related adverse events. Results: Clinical characteristics including stage of disease and comorbidity burden as well as receipt of chemotherapy from a provider affiliated with the National Cancer Institute's (NCI) Community Clinical Oncology Program (CCOP) were independent predictors of the use of bevacizumab. Median survival was 9.8 months among patients receiving bevacizumab plus platinum-based doublet chemotherapy and 8.9 months among patients receiving chemotherapy alone (hazard ratio [HR], 1.02; 95% CI, 0.91 to 1.13; P = 0.76). Neither multivariable nor propensity score-adjusted Cox models demonstrated a survival advantage with the addition of bevacizumab to platinum-based chemotherapy. Compared to platinum-based doublet chemotherapy alone, the addition of bevacizumab was associated with a higher incidence of hospitalization for any severe treatment-related adverse event (10% vs. 14%, respectively; P = 0.003); however, this association was not statistically significant after adjusting for confounders in a multivariable-adjusted Cox proportional hazards model (HR, 1.31; 95% CI, 0.94 to 1.79). Conclusions: Patient clinical characteristics and provider affiliation with the CCOP were important predictors of bevacizumab use. However, adding bevacizumab to platinum-based doublet chemotherapy was not associated with better survival among Medicare patients with advanced NSCLC.
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  • In Copyright
Advisor
  • Farley, Joel
Degree
  • Doctor of Philosophy
Graduation year
  • 2013
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