Outcomes for elderly, advanced-stage non small-cell lung cancer patients treated with bevacizumab in combination with carboplat

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J Clin Oncol. 2008 Jan 1;26(1):60-5. 

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J Clin Oncol. 2008 Apr 20;26(12):2062-3; author reply 2064-5.
J Clin Oncol. 2008 Apr 20;26(12):2063-4; author reply 2064-5.
J Clin Oncol. 2008 Jan 1;26(1):13-5.

Outcomes
for elderly, advanced-stage non small-cell lung cancer patients treated
with bevacizumab in combination with carboplatin and paclitaxel:
analysis of Eastern Cooperative Oncology Group Trial 4599.

 
Ramalingam SS, Dahlberg SE, Langer CJ, Gray R, Belani CP, Brahmer JR, Sandler AB, Schiller JH, Johnson DH; Eastern Cooperative Oncology Group.
Division
of Hematology-Oncology, Department of Medicine, University of
Pittsburgh School of Medicine, Pittsburgh, USA.

PURPOSE: Fit
elderly patients with advanced non-small-cell lung cancer (NSCLC)
benefit from platinum-based, two-drug chemotherapy. Bevacizumab (B) in
combination with carboplatin (C) and paclitaxel (P) improves survival
for advanced, nonsquamous NSCLC, as evidenced in Eastern Cooperative
Oncology Group (ECOG) 4599. We conducted a subset analysis of ECOG 4599
to determine the outcome for elderly patients.
PATIENTS AND METHODS:
ECOG 4599 randomly assigned patients with advanced nonsquamous NSCLC to
PC or to PCB. We analyzed outcome in patients who were at least 70
years of age at the time of study entry. Patient characteristics,
efficacy, and toxicity data were compared between PC and PCB for the
elderly. Outcomes for elderly and younger patients (< 70 years)
treated with PCB were also compared.
RESULTS: Among elderly patients (n
= 224; 26%), there was a trend towards higher response rate (29% v 17%;
P = .067) and progression-free survival (5.9 v 4.9 months; P = .063)
with PCB compared with PC, although overall survival (PCB = 11.3
months; PC = 12.1 months; P = .4) was similar. Grade 3 to 5 toxicities
occurred in 87% of elderly patients with PCB versus 61% with PC (P <
.001), with seven treatment-related deaths in the PCB arm compared with
two with PC. Elderly patients had higher incidence of grade 3 to 5
neutropenia, bleeding, and proteinuria with PCB compared with younger
patients.
CONCLUSION: In elderly NSCLC patients, PCB was associated
with a higher degree of toxicity, but no obvious improvement in
survival compared with PC. Data from this unplanned, retrospective
analysis justify prospective evaluation of the therapeutic index of PCB
regimen in elderly patients.