Abstract
Bevacizumab is FDA-approved in the treatment of primary brain tumors, but its efficacy in patients with brain metastases could be better-studied. This study examines a population of non-small cell lung cancer (NSCLC) patients with synchronous brain metastases to identify predictors of the decision to use bevacizumab and survival following bevacizumab treatment. Primary cancer registry data were used to determine which NSCLC patients diagnosed in the years 2010 through 2012 had synchronous brain metastases at the time of diagnosis, and Medicare claims used to identify a population of patients treated with bevacizumab. Record of bevacizumab treatment was found for 81 and 666 patients with and without brain metastases, respectively. After adjusting for clinical and demographic characteristics, bevacizumab was associated with 0.88 times the hazard of mortality in the elderly NSCLC population (95% CI: 0.81–0.96, p: 0.003) and a corresponding hazard ratio of 0.75 in the population of elderly NSCLC patients with synchronous brain metastases (95% CI: 0.59–0.96, p: 0.020). Bevacizumab may benefit NSCLC patients with synchronous brain metastases more than it does patients without intracranial disease, possibly as a result of its multiple potential mechanisms of action simultaneously inhibiting angiogenesis and minimizing vasogenic edema.
Highlights
Bevacizumab is FDA-approved in the treatment of primary brain tumors, but its efficacy in patients with brain metastases could be better-studied
Though several studies have addressed the safety of bevacizumab treatment for brain metastases (BM), its efficacy for this purpose is less well-explored: one meta-analysis reports that, of 57 anti-VEGF treatment studies, 76% explicitly stated the presence of central nervous system metastases was among exclusion criteria, and only four studies reported on its use treating patients with BM8–12
This study identifies non-small cell lung cancer (NSCLC) patients with and without SBM treated with bevacizumab using Medicare claims data and evaluates the survival benefit of treatment with respect to primary cancer characteristics available from SEER, while further adjusting for treatment with several commonly-used chemotherapeutic agents
Summary
Bevacizumab is FDA-approved in the treatment of primary brain tumors, but its efficacy in patients with brain metastases could be better-studied. Primary cancer registry data were used to determine which NSCLC patients diagnosed in the years 2010 through 2012 had synchronous brain metastases at the time of diagnosis, and Medicare claims used to identify a population of patients treated with bevacizumab. Bevacizumab reduces the increase in vascular permeability that is associated with VEGF expression and helps relieve patients of the potentially serious morbidity and symptoms that accompany peritumoral edema[3]. This is important in the CNS as edema can lead to increased intracranial pressure in the fixed volume of the cranial vault, which has potentially fatal consequences. In 2016, the Surveillance, Epidemiology, and End-Results (SEER) program released its own data regarding diagnosis of BM during primary cancer staging workup; these high-fidelity cancer registry data may be related to healthcare claims, further opening the door to large-scale analysis of BM treatment and outcomes
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