In real-world community oncology settings, bevacizumab-containing regimens were associated with longer progression-free survival and overall survival compared with non-bevacizumab regimens.
First-line treatment options for advanced non-squamous non—small cell lung cancer (NSCLC) include platinum-based doublet therapy with or without bevacizumab. A study published online in Health and Quality of Life Outcomes, by Mark S. Walker, PhD, and colleagues reports that in real-world community oncology settings, bevacizumab-containing regimens were associated with longer progression-free survival (PFS) and overall survival (OS) compared with non-bevacizumab regimens in newly diagnosed advanced NSCLC. Researchers also assessed the impact of disease progression on health-related quality of life (HRQOL). The study was supported by Genentech, Inc.
The study analyzed data from 147 patients who were treated with first-line bevacizumab regimens or non-bevacizumab regimens in 34 community oncology practices in the United States. Bevacizumab regimens (regimen A) were platinum doublet, gemcitabine doublet, and pemetrexed with platinum (n = 66; 44.9%). Non-bevacizumab regimens (regimen B) were platinum doublet, gemcitabine doublet (n = 25; 17.0%) or (regimen C) pemetrexed with platinum (n = 56; 38.1%). Routine care records were used to gather patient characteristics and clinical outcomes.
A total of 145 patients also provided follow-up patient-reported outcomes (PRO) data. At each visit and up to 1 year of follow-up, 3 validated and widely used PRO measures of HRQOL and symptom burden were collected prospectively. Effectiveness outcomes were PFS and OS assessed by Kaplan-Meier and Cox regression methods. PROs were analyzed with linear mixed-model regression to examine changes over time, as well as the effect of disease progression.
Regimen A was associated with significantly longer OS than regimen B (Hazard ratio [HR], 0.341, P = .0012) and significantly longer than regimen C (HR = 0.602, P = .0354). PFS results were similar. Irrespective of regimen, and on 12 of 32 PRO-based measures, patients showed significant and clinically meaningful worsening of symptoms and HRQOL at disease progression. After disease progression, the pattern of symptom and HRQOL change showed continued worsening.
Median PFS in first-line treatment was 5.59 months overall, with 141 events in the 147 patients. Median OS was 9.67 months overall, with 102 events observed. Cox regression analysis of OS, controlling for demographic and clinical covariates, showed significant variability in OS by treatment regimen (P = .0040). Pairwise comparisons showed that regimen A was associated with significantly longer OS than regimen B; regimen A was also associated with significantly longer OS than regimen C. Male gender, stage IV at diagnosis, impaired performance status, and higher comorbid disease burden were associated with shorter OS. Ninety-three patients (63.3%) had at least 1 adverse event (AE), with no significant differences between regimen groups in the rate at which patients had AEs.
The researchers point out that patients did experience significant worsening of symptoms and HRQOL at disease progression following first-line treatment of advanced NSCLC. The absence of significant differences in HRQOL among treatment regimen groups was not expected, the authors note, and they believe it may have been a result of their choice of statistical model rather than a consequence of a complete lack of a treatment effect. “This research showed improved effectiveness outcomes, including significantly longer OS, associated with bevacizumab-containing treatment regimens in first-line advanced nonsquamous NSCLC,” they conclude—benefits that were devoid of significant AEs or measurable negative impact on QOL. However, the study identified a significant adverse impact of disease progression in general. “Given these findings, improved effectiveness outcomes, whether due to chosen therapies or differences in patient management, may potentially be viewed as conferring HRQOL benefits.”