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Outcomes for Elderly, Advanced-Stage Non–Small-Cell Lung Cancer Patients Treated With Bevacizumab in Combination With Carboplatin and Paclitaxel: Analysis of Eastern Cooperative Oncology Group Trial 4599

Suresh S. Ramalingam, Suzanne E. Dahlberg, Corey J. Langer, Robert Gray, Chandra P. Belani, Julie R. Brahmer, Alan B. Sandler, Joan H. Schiller, David H. Johnson

From the Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh; Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; The Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Vanderbilt-Ingram Cancer Center, Nashville, TN; and The University of Texas Southwestern Medical Center, Dallas, TX

Corresponding author: Suresh S. Ramalingam, MD, Emory Winship Cancer Institute, 1365 Clifton Rd, Room C-5090, Atlanta, GA 30322; e-mail: suresh.ramalingam{at}emory.edu

Purpose Fit elderly patients with advanced non–small-cell lung cancer (NSCLC) benefit from platinum-based, two-drug chemotherapy. Bevacizumab (B) in combination with carboplatin (C) and paclitaxel (P) improves survival for advanced, nonsquamous NSCLC, as evidenced in Eastern Cooperative Oncology Group (ECOG) 4599. We conducted a subset analysis of ECOG 4599 to determine the outcome for elderly patients.

Patients and Methods ECOG 4599 randomly assigned patients with advanced nonsquamous NSCLC to PC or to PCB. We analyzed outcome in patients who were at least 70 years of age at the time of study entry. Patient characteristics, efficacy, and toxicity data were compared between PC and PCB for the elderly. Outcomes for elderly and younger patients (< 70 years) treated with PCB were also compared.

Results Among elderly patients (n = 224; 26%), there was a trend towards higher response rate (29% v 17%; P = .067) and progression-free survival (5.9 v 4.9 months; P = .063) with PCB compared with PC, although overall survival (PCB = 11.3 months; PC = 12.1 months; P = .4) was similar. Grade 3 to 5 toxicities occurred in 87% of elderly patients with PCB versus 61% with PC (P < .001), with seven treatment-related deaths in the PCB arm compared with two with PC. Elderly patients had higher incidence of grade 3 to 5 neutropenia, bleeding, and proteinuria with PCB compared with younger patients.

Conclusion In elderly NSCLC patients, PCB was associated with a higher degree of toxicity, but no obvious improvement in survival compared with PC. Data from this unplanned, retrospective analysis justify prospective evaluation of the therapeutic index of PCB regimen in elderly patients.

Presented as a poster at the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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Related Editorial

• Treatment of Advanced Non–Small-Cell Lung Cancer in the Elderly: From Best Supportive Care to the Combination of Platin-Based Chemotherapy and Targeted Therapies
  Cesare Gridelli
  JCO 2008 26: 13-15 [Full Text]

Related Correspondence

• Reporting of Subset Analysis: Where Do We Draw the Line?
  Sanjay Goel
  JCO 2008 26: 2062-2063 [Full Text]
• Improved Survival With Addition of Bevacizumab to Paclitaxel and Carboplatin in Elderly Patients With Non–Small-Cell Lung Cancer
  Carl D. Atkins
  JCO 2008 26: 2063-2064 [Full Text]

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