Avastin for Lung Cancer

One of the most interesting aspects of a newly published study of bevacizumab (Avastin) for older patients with advanced non-small cell lung cancer (NSCLC) is the abstract’s conclusion:

“Adding bevacizumab to carboplatin and paclitaxel chemotherapy was not associated with better survival among Medicare patients with advanced NSCLC.”

It’s refreshing to see no extra flourishes added, no unnecessary words trying to imply that somehow the drug might be of some benefit to some patients maybe. Of course better treatments are needed for older people suffering from advanced lung cancer, but there’s no use forcing a combination if it doesn’t work.

The study, conducted by several physicians at the Dana-Farbar Cancer Institute, was actually a retrospective examination. A total of 4,168 patients with NSCLC, all age 65 years or older and all Medicare beneficiaries, all diagnosed between 2002 and 2007, were split into three groups, as follows:

Group 1: Diagnosed in 2006-2007; initial chemotherapy with bevacizumab-carboplatin-paclicataxel

Group 2: Diagnosed 2006-2007; initial chemotherapy with carboplatin-paclitaxel (so same as above minus bevacizumab)

Group 3: Diagnosed 2002-2005; initial chemotherapy with carboplatin-paclitaxel

Overall survival measured from the first date of chemotherapy treatment until death, or the “censoring date” of December 31, 2009, served as the primary outcome of the study.

According to the report, just published in JAMA, the median survival estimates were:

Group 1: 9.7 months; interquartile range, 4.4–18.6
Group 2: 8.9 months; IQR, 3.5–19.3
Group 3: 8.0 months; IQR, 3.7–17.2

One-year survival probabilities were:

Group 1: 39.6% (95% confidence interval, 34.6%–45.4%)
Group 2: 40.1% (95% CI, 37.4% –43.0%)
Group 3: 35.6% (95% CI, 33.8%–37.5%)

Importantly, the authors state in the abstract: “Subgroup and sensitivity analyses for key variables did not change these findings.”

Bevacizumab is already approved for advanced NSCLC, where it is given in combination with carboplatin and paclitaxel for patients who have not received chemotherapy for advanced disease already. (The drug is also approved for the treatment of metastatic colorectal cancer, metastatic kidney cancer, and glioblastoma.) This new report seems to suggest that the triple combination for NSCLC should probably be confined to patients under 65 years of age. (NOTE: I am NOT a doctor and am not qualified to offer any opinions on cancer treatments.)

Numerous clinical trials of bevacizumab for cancer are ongoing. Some are sponsored by competitors seeking to compare their drug to a bevacizumab-containing regimen, and others are focused on combining bevacizumab with other agents such as AZD2171, temozolomide, Revlimid, and many others.

And for anyone seeking additional context about bevacizumab in the treatment of cancer, here are some of my previous posts. Looking at this list, you might begin to question the sanity of a writer so interested in a single drug. But tracing the history of this drug provides powerful insights about clinical trials, the drug development process, FDA review of new drugs, weighing benefits against side effect risks, and how to consider cost in healthcare decisions. When a single thread tells this much of a story, it’s worth following.

Avastin for Ovarian Cancer
Let the Death Panel Accusations Fly! (On the withdrawal of FDA approval of Avastin for breast cancer)
Taking a Stab at Cost-Effectiveness
The Avastin Saga

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