The addition of Avastin (bevacizumab) to the standard chemotherapy regimen for non-small cell lung cancer (NSCLC) did not improve survival rates in patients over age 65 with advanced NSCLC, according to the results of a study published in the Journal of the American Medical Association.
Lung cancer remains the leading cause of cancer death in the United States. Non–small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers.
Avastin is a targeted therapy that blocks a protein known as VEGF. VEGF plays a key role in the development of new blood vessels. By blocking VEGF, Avastin deprives the cancer of nutrients and oxygen and inhibits its growth.
Previous studies have shown improved survival with the addition of Avastin to standard chemotherapy regimens (carboplatin and paclitaxel) for NSCLC; however, these results have not been observed in older patients. In order to examine the efficacy of this approach in older patients, researchers from the Dana-Farber Cancer Institute examined data from 4,168 Medicare patients age 65 years or older with stage IIIB or IV NSCLC diagnosed between 2002 and 2007.
They measured survival rates in three groups of patients: 1) patients who received Avastin plus carboplatin/paclitaxel; 2) patients who received carboplatin/paclitaxel between 2006-2007; and 3) those who received carboplatin/paclitaxel between 2002-2005.
The median overall survival was 9.7 months for patients receiving Avastin plus standard therapy, compared to 8.9 months for the 2006-2007 standard-therapy group and 8.0 months for the 2002-2005 standard-therapy group. For those receiving Avastin plus standard therapy, the probability of surviving one year was 39.6%, compared to 40.1% for the 2006-2007 standard-therapy group and 35.6% for the 2002-2005 standard-therapy group.
The researchers concluded that the addition of Avastin to standard chemotherapy did not provide a substantial survival advantage for patients over 65. They recommend that Avastin should not be automatically administered with standard chemotherapy in older patients with NSCLC and instead physicians should determine treatment regimens for older patients on a case-by-case basis.
 Zhu J, Sharma DB, Gray SW, et al. Carboplatin and paclitaxel with vs without bevacizumab in older patients with advanced non–small cell lung cancer. JAMA. 2012; 307(15): 1593-1601.
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