Comparative Effectiveness of Carboplatin/Pemetrexed With Versus Without Bevacizumab for Advanced Nonsquamous Non-Small Cell Lung Cancer
Comparative Effectiveness of Carboplatin/Pemetrexed With Versus Without Bevacizumab for Advanced Nonsquamous Non-Small Cell Lung Cancer
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DOI：
10.6004/jnccn.2018.7102
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发表时间：
2019-05-01
影响因子：
13.4
通讯作者：
Vachani, Anil
中科院分区：
文献类型：
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作者：
Bagley, Stephen J.;Talento, Suzanna;Vachani, Anil
工作背景：尽管晚期非小细胞肺癌（NSCLC）的靶向治疗和免疫治疗取得了最新进展，但卡铂/培美曲塞/贝伐珠单抗仍然是常用的一线治疗方案。然而，目前尚不清楚贝伐珠单抗与卡铂/培美曲塞联合使用是否能改善总生存期（OS）。材料与方法：我们使用Flatiron Health的全国代表性电子健康记录数据，对接受≥ 1个周期卡铂/培美曲塞+/-贝伐珠单抗作为IV期或转移性/复发性疾病初始全身治疗的晚期非鳞状NSCLC患者进行了一项回顾性队列研究。使用考克斯比例风险模型评估贝伐珠单抗联合卡铂/培美曲塞对OS的影响，以调整年龄、性别、人种、原发肿瘤分期、诊断转移性疾病与开始化疗之间的时间以及体能状态。在对一个学术机构的患者进行的二次分析中，我们还调整了脑转移、咯血和抗凝治疗的存在。结果如下：共纳入4，724例患者，其中2，759例患者（58%）接受卡铂/培美曲塞，1，965例患者（42%）接受卡铂/培美曲塞/贝伐珠单抗。卡铂/培美曲塞/贝伐珠单抗组的中位OS为12.1个月（95%CI，11.2-12.9个月），而卡铂/培美曲塞组的中位OS为8.6个月（95%CI，8.1-9.1个月）（P
Background: Despite recent advances in targeted therapy and immunotherapy for advanced non-small cell lung cancer (NSCLC), carboplatin/pemetrexed/bevacizumab remains a commonly used first-line regimen. However, it is unknown whether the addition of bevacizumab to carboplatin/pemetrexed improves overall survival (OS). Materials and Methods: Using nationally representative curated electronic health record data from Flatiron Health, we performed a retrospective cohort study of patients diagnosed with advanced nonsquamous NSCLC who received >= 1 cycle of carboplatin/pemetrexed +/- bevacizumab as initial systemic therapy for stage IV or metastatic/recurrent disease. The OS impact of adding bevacizumab to carboplatin/pemetrexed was assessed using a Cox proportional hazards model to adjust for age, sex, race, original tumor stage, time between diagnosis of metastatic disease and start of chemotherapy, and performance status. In a secondary analysis of patients at a single academic institution, we also adjusted for the presence of brain metastases, hemoptysis, and anticoagulation. Results: A total of 4,724 patients were included, of which 2,759 patients (58%) received carboplatin/pemetrexed and 1,965 (42%) received carboplatin/pemetrexed/bevacizumab. Median OS was 12.1 months (95% CI, 11.2-12.9 months) in the carboplatin/pemetrexed/bevacizumab group compared with 8.6 months (95% CI, 8.1-9.1 months) in the carboplatin/pemetrexed group (P