Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
John Cavenagh, PhD, PA-C
OBJECTIVE: The objective of this selective EBM review is to determine whether or not bevacizumab (avastin) is safe and effective as adjuvant chemotherapy for adult patients with stage IIIb or IV non-small cell lung carcinoma (NSCLC).
STUDY DESIGN: Review of three randomized controlled trials (RCT) published in 2006, 2009, and 2011, all English language.
DATA SOURCES: Two randomized, double-blind, controlled clinical trials comparing bevacizumab to placebo as adjunctive chemotherapy, and one RCT comparing bevacizumab as adjunctive chemotherapy versus the use of no adjunctive chemotherapy. All articles were found using PubMed, Medline, and OVID.
OUTCOMES MEASURED: Overall survival (OS) and progression-free survival (PFS) were measured. OS was defined as time from randomization to death from any cause. PFS was defined as time from randomization to first documented disease progression or death on study treatment, whichever occurred first. Event-time distributions were estimated using the Kaplan-Meier method.
RESULTS: Herbst et al2 and Reck et al6 compared traditional chemotherapy plus bevacizumab to traditional chemotherapy plus placebo, and Sandler et al3 compared traditional chemotherapy plus bevacizumab to traditional chemotherapy alone. Herbst et al2 failed to find a significant difference in OS or PFS between subjects using adjuvant bevacizumab and those using traditional chemotherapy. Reck et al6 was unable to assess OS; however, the investigators reported that PFS was significantly improved with the addition of bevacizumab to traditional chemotherapy. Sandler et al3 established that the addition of bevacizumab to traditional chemotherapy has statistically significant survival benefits in patients with NSCLC.
CONCLUSIONS: From the research performed and results obtained, the evidence is inconclusive and conflicting to support the use of bevacizumab as adjuvant chemotherapy for stage IIIb or IV NSCLC. With inconsistencies and differing results among the three RCTs, further research would be helpful to confirm or negate the question of whether bevacizumab is actually beneficial as adjuvant therapy. In addition to researching the efficacy and safety of bevacizumab as adjuvant chemotherapy, it would be advantageous to study the efficacy and safety of bevacizumab as monotherapy. Further research is warranted to obtain more conclusive data.
De Kleine, Ashley R., "Is Bevacizumab (Avastin) Safe and Effective as Adjuvant Chemotherapy for Adult Patients With Stage IIIb or IV Non-Small Cell Lung Carcinoma (NSCLC)?" (2014). PCOM Physician Assistant Studies Student Scholarship. 160.