Bevacizumab Could Help Patients With NSCLC Who Cannot Receive PD-1 Inhibitors

Patients with advanced nonsquamous non—small cell lung cancer (NSCLC) have been shown to benefit from the addition of the immune checkpoint inhibitor pembrolizumab to first-line carboplatin and pemetrexed regardless of programmed death ligand-1 (PD-L1) expression. However, some patients cannot receive PD-1 inhibitors because of comorbidities, or because they lack access. In such cases, says a new study, bevacizumab (Avastin, which has 1 FDA-approved biosimilar, Mvasi) may be an option.

The study, conducted by researchers at the Abramson Cancer Center at the University of Pennsylvania, used deidentified electronic health record data, representing more than 260 cancer clinics, from Flatiron Health’s database. The investigators assessed a cohort of 4724 patients with advanced NSCLC.

In total, 2759 patients received carboplatin and pemetrexed, and 1965 received carboplatin and pemetrexed plus bevacizumab. The investigators found that median overall survival (OS) was 12.1 months (95% CI, 11.2-12.9) in the carboplatin and pemetrexed plus bevacizumab group versus with 8.6 months (95% CI, 8.1-9.1) in the carboplatin and pemetrexed group (P <.001). Bevacizumab was also associated with improved OS in a multivariate model (hazard ratio, 0.80; 95% CI, 0.75-0.86; P <.001).

In a cohort of patients who were treated at the University of Pennsylvania, data collected via manual chart abstraction allowed for a secondary analysis that showed that the survival benefit was maintained after adjusting for potential confounders of the relationship between bevacizumab use and survival, including brain metastases, anticoagulation use, and recent history of hemoptysis. Bevacizumab also proved to be beneficial in subgroups limited to patients who were elderly.

“Our results suggest that in patients with a contraindication to immunotherapy, such as connective tissue, rheumatologic, or interstitial lung disease, bevacizumab may be a reasonable alternative, instead of pembrolizumab, to add to carboplatin-pemetrexed,” said lead author, Stephen J. Bagley, MD, MSCE, assistant professor of hematology-oncology at Abramson Cancer Center, in a statement.

“Many oncologists were already using carboplatin-pemetrexed-bevacizumab for patients with advanced non-squamous NSCLC, but this study suggests there is indeed an improvement in overall survival when bevacizumab is added. What’s more, I was surprised to learn that the survival benefit of bevacizumab persisted even in older patients and after adjusting for brain metastases, hemoptysis, and anticoagulation use,” Bagley added.

Bagley and his coauthors write that these real-world results can help in the complex clinical decision-making necessary for patients with NSCLC.

Reference

Bagley SJ, Talento S, Mitra N, et al. Comparative effectiveness of carboplatin/pemetrexed with versus without bevacizumab for advanced nonsquamous non—small cell lung cancer. J Natl Compr Canc Netw. 2019;17(5). doi: 10.6004/jnccn.2018.7102.