title: Toxicity of bevacizumab in combination with chemotherapy in older patients.
abstract: BACKGROUND
  Bevacizumab leads to improved survival for patients with metastatic colorectal cancer (CRC) or non-small cell lung cancer (NSCLC) when added to chemotherapy. Little is known about factors associated with receipt of bevacizumab, or whether bevacizamab is associated with increased toxicity when added to chemotherapy.
  
  
  METHODS
  We conducted a prospective study of patients aged ≥65 years, which evaluated the association between geriatric assessment (GA) metrics and chemotherapy toxicity. We examined differences in characteristics and outcomes of patients with CRC and NSCLC cancers who received bevacizumab with chemotherapy versus chemotherapy alone.
  
  
  RESULTS
  From a total of 207 patients, 27 (13%) received bevacizumab plus chemotherapy and 180 (87%) received chemotherapy alone. Groups were similar in sociodemographic and cancer characteristics. There were no baseline differences in GA domains except that patients with heart disease were less likely to receive bevacizumab (4% vs. 26%, p = .01). Seventy-eight percent of patients who had bevacizumab had grade 3-5 toxicity compared to only 57% who received chemotherapy alone (p = .06). Patients receiving bevacizumab were more likely to develop grade 3 hypertension than those who received chemotherapy alone (15% vs. 2%, p < .01). In multivariable analysis, factors associated with grade 3 or more toxicity included: bevacizumab (OR: 2.86, p = .04), CRC (OR: 2.54, p < .01), and baseline anemia (OR: 2.58, p = .03).
  
  
  CONCLUSIONS
  Heart disease was more common in those who did not receive bevacizumab. Older patients who receive bevacizumab with chemotherapy have a higher odds of developing a grade 3-5 toxicity compared with those who receive chemotherapy alone.
authors.affiliation: University of Rochester Medical Center, Wilmot Cancer Center, Rochester, New York, USA.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
authors.forename: Molly
authors.initials: M
authors.lastname: Hardt
authors.forename: William
authors.initials: W
authors.lastname: Tew
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.forename: Heidi
authors.initials: H
authors.lastname: Klepin
authors.forename: Cary
authors.initials: C
authors.lastname: Gross
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Lichtman
authors.forename: Tao
authors.initials: T
authors.lastname: Feng
authors.forename: Kayo
authors.initials: K
authors.lastname: Togawa
authors.forename: Rupal
authors.initials: R
authors.lastname: Ramani
authors.forename: Vani
authors.initials: V
authors.lastname: Katheria
authors.forename: Kurt
authors.initials: K
authors.lastname: Hansen
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D000068258:Bevacizumab; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018572:Disease-Free Survival; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011446:Prospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab