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Improved Survival With Addition of Bevacizumab to Paclitaxel and Carboplatin in Elderly Patients With Non–Small-Cell Lung Cancer

South Shore Hematology-Oncology Associates, Rockville Centre, NY

To the Editor:

The statement made by Ramalingam et al¹ that "there were no differences" in overall survival between elderly patients with non–small-cell lung cancer treated with paclitaxel and carboplatin (PC) with or without bevacizumab is not supported by their data. They note that in a Cox model adjusted for treatment and other factors, PC treatment was associated with significantly worse survival (P = .01). This is obvious from the survival curve in their Figure 1A¹, which highlights the problem with relying on median survival as the sole summary statistic for evaluating differences in survival (median survival was slightly, nonsignificantly shorter in the PC group). Ramalingam et al¹ also fail to report an analysis of the adequacy of the assumption of proportional hazards of their Cox model—a serious oversight.² The survival curve does not look like the assumption of proportionality will hold, and the inclusion of a time-dependent variable might be required.³ I expect that this would make the statistical significance of the survival difference even stronger.

AUTHOR'S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The author(s) indicated no potential conflicts of interest.

REFERENCES

1. Ramalingam SS, Dahlberg SE, Langer CJ, et al: Outcomes for elderly, advanced-stage non–small-cell lung cancer patients treated with bevacizumab in combination with carboplatin and paclitaxel: Analysis of Eastern Cooperative Group Trial 4599. J Clin Oncol 26:60-65, 2008[Abstract/Free Full Text]

2. Begg C, Cho M, Eastwood S, et al: Improving the quality of reporting of randomized controlled trials: The CONSORT statement. JAMA 276:637-639, 1996[CrossRef][Medline]

3. Greenland, S: Introduction to regression models, in Rothman KJ, and S Greenland (eds): Modern Epidemiology (ed 2). Philadelphia, PA, Lippincott-Raven, 1998, pp 359-399

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