title: Effectiveness of bevacizumab and cetuximab in metastatic colorectal cancer across selected public hospitals in Queensland.
abstract: OBJECTIVE
  Metastatic colorectal cancer has a large burden of disease in Australia. Medical therapy is fundamental to extending survival and improving quality of life. The benefits of two costly medicines, bevacizumab and cetuximab, used in Australia remain unclear. The aim of this study was to retrospectively examine the use of these two medicines in metastatic colorectal cancer across five public hospitals in south east Queensland and to compare clinical outcomes to those of published clinical trials.
  
  
  METHODS
  We extracted data from the chemotherapy prescribing database for patients planned for bevacizumab or cetuximab therapy between 2009 and 2013. Median overall survival was estimated using Kaplan-Meier methods.
  
  
  RESULTS
  There were 490 bevacizumab-containing protocols planned and 292 patients received at least one dose of bevacizumab. Median overall survival was 17.2 months (95% confidence interval [CI], 15.4-19.3). Of 208 planned cetuximab-containing protocols, 134 patients received at least one dose of cetuximab. Median overall survival was 9.1 months (95% CI, 7.6-12.0). Thirty-day mortality rates from date of first dose were 0.7% for bevacizumab and 7.5% for cetuximab.
  
  
  CONCLUSIONS
  Overall survival of patients receiving bevacizumab and cetuximab was consistent with clinical trials, providing some assurance that benefits seen in trials are observed in usual practice. This study provides a methodology of using routinely collected health data for clinical monitoring and research. Because of the high cost of these medicines and the lack of toxicity data in this study, further analysis in the postmarketing setting should be explored.
authors.affiliation: Pharmacy Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Suzannah J
authors.initials: SJ
authors.lastname: Chapman
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: McKavanagh
authors.affiliation: Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Burge
authors.affiliation: Pharmacist - Digital Hospital Program, Clinical Informatics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: McPherson
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
authors.forename: Euan
authors.initials: E
authors.lastname: Walpole
authors.affiliation: School of Pharmacy, The University of Queensland, Woolloongabba, Queensland, Australia.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Hollingworth
mesh_terms: D000368:Aged; D000074322:Antineoplastic Agents, Immunological / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000008:administration & dosage / Q000627:therapeutic use*; D000068818:Cetuximab / Q000008:administration & dosage / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000074322:Antineoplastic Agents, Immunological; D000068258:Bevacizumab; D000068818:Cetuximab
keywords: bevacizumab; cetuximab; colorectal neoplasm; postmarketing evaluation studies; survival