Factors associated with first-line bevacizumab use in advanced non-squamous and non-small cell lung cancer

Introduction: Bevacizumab was approved for treatment of advanced non-squamous, non-small cell lung cancer (NSCLC) in the US in late 2006. Information on its uptake and patient and tumor factors associated with its use is lacking. Materials and methods: This was a longitudinal, retrospective cohort study of patients with stage IIIB/IV non-squamous NSCLC aged 21 years or greater diagnosed between 2005 and 2010 at four Cancer Research Network sites. Patients were categorized as receiving first-line carboplatin-paclitaxel (CP) or carboplatin-paclitaxel-bevacizumab (CPB) within 120 days of diagnosis. Information on patient and tumor characteristics was obtained from queries of sites’ electronic tumor registries and administrative databases. Factors independently associated with CPB use were evaluated using bivariate and multivariate logistic regression analyses. Results: A total of 1109 patients with advanced NSCLC were included with 198 (17.9%) and 911 (82.1%) patients receiving CPB and CP, respectively. Bevacizumab use increased modestly during the study period, peaking in 2008 at 18.5%. In bivariate analyses, patients who received CPB were younger with less comorbidity and well to moderately differentiated tumors while patients who received CP were more likely to have had hypertension, peripheral vascular disease, and a prior hospitalization. Factors independently associated with CPB use included younger age, well/ moderately differentiated tumor grade, no prior hospitalization, and more recent study year. Conclusions: Use of bevacizumab in patients with advanced NSCLC increased rapidly then moderated. Younger patients and those with lower risks for adverse effects were more likely to receive bevacizumab.