title: Comparison of survival and hospitalization rates between Medicare patients with advanced NSCLC treated with bevacizumab-carboplatin-paclitaxel and carboplatin-paclitaxel: a retrospective cohort study.
abstract: OBJECTIVE
  The use of bevacizumab in advanced non-squamous non-small cell lung cancer (NSCLC) is controversial among elderly patients. This study aimed to compare overall survival for Medicare patients diagnosed with NSCLC and treated with either first-line bevacizumab-carboplatin-paclitaxel (BCP) or carboplatin-paclitaxel (CP).
  
  
  METHODS
  Patients ≥ 65 years old, first diagnosed with non-squamous NSCLC stage IIIB/IV between 2006 and 2009, and treated with either first-line BCP or CP, were selected from the SEER-Medicare database that links cancer registry and US Medicare claims data. Kaplan-Meier estimates were used to evaluate survival. Multivariable Cox proportional hazards models were used to compare the effect of BCP versus CP on the hazard of death. Age-stratified analyses were conducted for patients aged 65-74 and ≥ 75 years.
  
  
  RESULTS
  Of 1706 patients in the study sample, 592 (34.7%) received BCP and 1114 (65.3%) received CP; 692 (40.6%) were ≥ 75 years. Adjusted median survival time in the BCP versus CP cohorts was 10.5 versus 8.5 months (p = 0.008). The difference in median survival favoring the BCP cohort was statistically significant for both patients aged ≥ 75 years (2.8 months, p = 0.019), and patients aged 65-74 years (1.5 months, p = 0.018). The adjusted hazard of death did not differ between the cohorts (HR: 0.96, 95% CI: 0.86-1.06); however, during the first year of follow-up, when most deaths (>60%) occurred, the hazard of death was 18% lower for the BCP cohort (HR: 0.82, 95% CI: 0.71-0.94). BCP patients also had 18% fewer hospital admissions than CP patients (adjusted incidence rate ratio (IRR): 0.82, 95% CI: 0.72-0.94) and 23% fewer inpatient days (IRR: 0.77, 95% CI: 0.65-0.91).
  
  
  CONCLUSIONS
  In this retrospective analysis of Medicare patients in the SEER database, first-line therapy with BCP was associated with longer survival and fewer hospitalizations than CP.
authors.affiliation: Abramson Cancer Center and University of Pennsylvania in Philadelphia, Philadelphia, PA, USA. Electronic address: corey.langer@uphs.upenn.edu.
authors.forename: Corey
authors.initials: C
authors.lastname: Langer
authors.affiliation: Genentech, Inc., South San Francisco, CA, USA.
authors.forename: Arliene
authors.initials: A
authors.lastname: Ravelo
authors.affiliation: Genentech, Inc., South San Francisco, CA, USA.
authors.forename: Sebastien J
authors.initials: SJ
authors.lastname: Hazard
authors.affiliation: Analysis Group, Inc., Montreal, QC, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Guerin
authors.affiliation: Analysis Group, Inc., Montreal, QC, Canada.
authors.forename: Raluca
authors.initials: R
authors.lastname: Ionescu-Ittu
authors.affiliation: Analysis Group, Inc., Montreal, QC, Canada.
authors.forename: Dominick
authors.initials: D
authors.lastname: Latremouille-Viau
authors.affiliation: Analysis Group, Inc., Boston, MA, USA.
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Ramalingam
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D000068258:Bevacizumab; D016190:Carboplatin / Q000008:administration & dosage*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D016190:Carboplatin; D017239:Paclitaxel
keywords: Advanced NSCLC; Bevacizumab; First-line chemotherapy; Hospitalizations; Medicare; Survival