Abstract
BackgroundTreatment options for advanced nonsquamous non-small cell lung cancer (NSCLC) in the first line include platinum-based doublet therapy with or without bevacizumab. This study examined efficacy outcomes and patient reported outcomes (PROs) in a community oncology patient sample.MethodsAdvanced nonsquamous NSCLC patients from 34 U.S. community oncology practices treated in first line with bevacizumab regimens (A platinum doublet; gemcitabine doublet; pemetrexed with platinum) or non-bevacizumab regimens (B platinum doublet; gemcitabine doublet; C pemetrexed with platinum) were recruited for this prospective study. Patient characteristics and clinical outcomes were accessed from routine care records. Three validated and widely used PRO measures of health related quality of life (HRQOL) and symptom burden were collected prospectively at each visit and up to one-year follow-up. Effectiveness outcomes were progression free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier and Cox regression methods. PROs were analyzed with linear mixed model regression to examine changes over time, and the effect of disease progression.ResultsOf 147 patients in the study, 145 provided PRO data. Patients in treatment groups were: A (n = 66, 44.9%); B (n = 25, 17.0%); C (n = 56, 38.1%). A was associated with significantly longer OS than B (HR = 0.341, p = 0.0012), and significantly longer than C (HR = 0.602, p = 0.0354). PFS results were similar. Irrespective of regimen group and on 12/32 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.ConclusionsBevacizumab-containing regimens were associated with longer PFS and OS compared with non-bevacizumab regimens. PRO measures show disease progression is associated with worsening HRQOL. Delaying disease progression can sustain better HRQL and reduce symptom burden.
Highlights
Treatment options for advanced nonsquamous non-small cell lung cancer (NSCLC) in the first line include platinum-based doublet therapy with or without bevacizumab
One patient was removed from the study after it was discovered the patient was not eligible; eight patients who were consented provided no follow up data
Pairwise comparisons showed that Regimen A was associated with significantly longer progression free survival (PFS) than Regimen B (HR = 0.456, p = 0.0035), and Regimen A tended to be associated with longer PFS than Regimen C (HR = 0.701, p = 0.1070)
Summary
Treatment options for advanced nonsquamous non-small cell lung cancer (NSCLC) in the first line include platinum-based doublet therapy with or without bevacizumab. Standard first-line treatments for patients with advanced NSCLC have been platinum-based chemotherapy regimens. Randomized trials have shown that these platinum-based doublet regimens improve survival compared to single agents or best supportive care and are comparably active, producing one-year survival rates of approximately 30 to 40% with a median survival of 8 to 10 months [4,5,6,7]. The Eastern Cooperative Oncology Group (ECOG) Phase III trial (E4599) compared carboplatin paclitaxel with or without bevacizumab in a large cohort of stage IIIB-IV NSCLC patients and included bevacizumab maintenance therapy.
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