贝伐单抗辅助治疗晚期肺癌的比较疗效：癌症研究网络的经验
Comparative effectiveness of adjunctive bevacizumab for advanced lung cancer: the cancer research network experience.
作者信息
Ritzwoller Debra P, Carroll Nikki M, Delate Thomas, Hornbrook Mark C, Kushi Lawrence, Bowles Erin J Aiello, Loggers Elizabeth T, Menter Alex
机构信息
*The Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; †The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; ‡Division of Research, Kaiser Permanente Northern California, Oakland, California; §The Group Health Research Institute, Seattle, Washington; ‖Fred Hutchinson Cancer Research Center, Seattle, Washington; and ¶Department of Oncology, Kaiser Permanente Colorado, Denver, Colorado.
出版信息
J Thorac Oncol. 2014 May;9(5):692-701. doi: 10.1097/JTO.0000000000000127.
INTRODUCTION
Bevacizumab plus carboplatin-paclitaxel (BCP) chemotherapy has Food and Drug Administration approval for advanced nonsquamous, non-small-cell lung cancer based upon improved survival in a clinical trial. However, subgroup analyses of this and other studies have suggested variable results by age and gender.
METHODS
Using data from four health maintenance organizations (HMOs) belonging to the Cancer Research Network, 1605 HMO nonsquamous, non-small-cell lung cancer patients aged younger than 21 years, diagnosed 2002-2010, who received carboplatin-paclitaxel (CP), with and without bevacizumab for first-line treatment of stage IIIB/IV disease were identified. Patients were categorized into three groups based on year of diagnosis and regimen during 120 days postdiagnosis: (1) diagnosed 2005-2010 and received BCP; (2) 2005-2010, CP (CP2005), and (3) 2002-2004, CP (CP2002). Survival differences between groups were estimated using Cox proportional hazard models with several propensity score adjustments for demographic, comorbidity, and tumor characteristics. Multivariable subanalyses were also estimated.
RESULTS
Median survival was 12.3 months (interquartile range [IQR], 6.0-29.1) for BCP patients versus 8.8 months (IQR, 3.7-21.3) for CP2005 patients and 7.5 months (IQR, 3.8-15.6) for CP2002 patients. In the propensity score-adjusted models, BCP demonstrated a significant survival benefit with a hazard ratio of BCP relative to CP2005 and CP2002 patients of 0.79 (95% confidence interval [CI], 0.66-0.94) and 0.63 (95% CI, 0.52-0.75), respectively. In the multivariable-adjusted subanalyses, relative to the CP2005 cohort, the BCP hazard ratios for patients age less than 65 years, age 65 years old or older, and females were 0.78 (95% CI, 0.62-1.00), 0.74 (95% CI, 0.54-1.00), and 0.77 (95% CI, 0.58-1.00).
CONCLUSIONS
In this community-based, comparative effectiveness analysis, we found an overall survival benefit for adults receiving BCP compared with CP.
引言
贝伐单抗联合卡铂 - 紫杉醇（BCP）化疗已获美国食品药品监督管理局批准用于晚期非鳞状非小细胞肺癌，这是基于一项临床试验中生存期的改善。然而，该研究及其他研究的亚组分析表明，年龄和性别导致的结果存在差异。
方法
利用癌症研究网络所属的四个健康维护组织（HMO）的数据，确定了1605例年龄小于21岁、2002 - 2010年诊断为非鳞状非小细胞肺癌、接受卡铂 - 紫杉醇（CP）治疗（无论是否联合贝伐单抗）用于ⅢB/Ⅳ期疾病一线治疗的HMO患者。根据诊断年份和诊断后120天内的治疗方案，将患者分为三组：（1）2005 - 2010年诊断并接受BCP治疗；（2）2005 - 2010年，接受CP治疗（CP2005）；（3）2002 - 2004年，接受CP治疗（CP2002）。使用Cox比例风险模型对人口统计学、合并症和肿瘤特征进行多次倾向评分调整，估计各组之间的生存差异。还进行了多变量亚组分析。
结果
BCP组患者的中位生存期为12.3个月（四分位间距[IQR]，6.0 - 29.1），CP2005组患者为8.8个月（IQR，3.7 - 21.3），CP2002组患者为7.5个月（IQR，3.8 - 15.6）。在倾向评分调整模型中，BCP显示出显著的生存获益，相对于CP2005和CP2002患者，BCP的风险比分别为0.79（95%置信区间[CI]，0.66 - 0.94）和0.63（95%CI，0.52 - 0.75）。在多变量调整亚组分析中，相对于CP2005队列，年龄小于65岁、65岁及以上的患者以及女性患者的BCP风险比分别为0.78（95%CI，0.62 - 1.00）、0.74（95%CI，0.54 - 1.00）和0.77（95%CI，0.58 - 1.00）。
结论
在这项基于社区的比较有效性分析中，我们发现与CP相比，接受BCP治疗的成年人总体生存获益。
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