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Addition of Bevacizumab to Carboplatin/Pemetrexed in Nonsquamous NSCLC

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Key Points

  • The median overall survival improved to 12.1 months in the bevacizumab group vs 8.6 months in the group treated without bevacizumab, even after adjusting for prognostic variables.
  • In a second cohort including patients from Abramson Cancer Center, an academic institution, the overall survival benefit gain was even greater when bevacizumab was added.

New research published by Bagley et al in JNCCN—Journal of the National Comprehensive Cancer Network used a large real-world data set to demonstrate a modest but consistent survival benefit associated with adding bevacizumab to carboplatin/pemetrexed in advanced nonsquamous non–small cell lung cancer (NSCLC). This combination is already a common clinical practice, but there has never been a randomized prospective clinical trial to determine whether adding bevacizumab confers any survival benefit.

“Our results suggest that in patients with a contraindication to immunotherapy, such as connective tissue, rheumatologic, or interstitial lung disease, bevacizumab may be a reasonable alternative, instead of pembrolizumab, to add to carboplatin/pemetrexed,” said lead study author Stephen J. Bagley, MD, MSCE, Assistant Professor of Hematology-Oncology at the Abramson Cancer Center, in a press release. “Many oncologists were already using carboplatin/pemetrexed/bevacizumab for patients with advanced nonsquamous NSCLC, but this study suggests there is indeed an improvement in overall survival when bevacizumab is added. What’s more, I was surprised to learn that the survival benefit of bevacizumab persisted even in older patients and after adjusting for brain metastases, hemoptysis, and anticoagulation use.”

Results

The retrospective study used nationally representative electronic health record (EHR) data from Flatiron Health and supplemented these data with the researchers’ institutional experience to account for confounding clinical variables not captured in the Flatiron database. These data cover a total of 4,724 patients with lung cancer treated between January 1, 2011, and June 30, 2017, across more than 260 community cancer clinics. About 58% (n = 2,759) received carboplatin/pemetrexed, whereas 42% (n = 1,965) received carboplatin, pemetrexed, and bevacizumab.

The median overall survival improved to 12.1 months in the bevacizumab group vs 8.6 months in the group treated without bevacizumab, even after adjusting for prognostic variables. In a second cohort including patients from Abramson Cancer Center, an academic institution, the overall survival benefit gain was even greater when bevacizumab was added.

Study Implications

“Despite a lack of randomized clinical trial data, carboplatin and pemetrexed in combination with bevacizumab is a regimen that is used for treating naive patients with advanced nonsquamous NSCLC. Now, with the approval of immunotherapy-containing regimens, this therapeutic approach is reserved for those who are not candidates for immunotherapy,” commented Ticiana Leal, MD, Assistant Professor of Medicine, University of Wisconsin Carbone Cancer Center and a member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Non–Small Cell Lung Cancer.

“In the NCCN Guidelines®, this regimen is included as a category 2A recommendation. While the study is limited by its retrospective and nonrandomized nature, potential confounders, and lack of analysis for cost and toxicity burden, the analysis does provide additional support for the incorporation of bevacizumab in the treatment of advanced NSCLC for selected patients,” she continued.

Disclosure: For full disclosures of the study authors, visit jnccn.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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