Bevacizumab as first-line treatment in advanced non-squamous non-small cell lung cancer (NSCLC) in patients aged over 65 years in France: Final results of the AVANTAGE study
Authors: F. Lionel, D. Perol, P.-J. Souquet, H. Le Caer, E. Dansin, C. Audigier Valette, J.-L. Mouysset, M.L. Uffredi, M. Ionescu-Goga, K. Veerabudun, Y. Lelarge, E. Fabre-Guillevin
Journal: Annals of Oncology (2018)

Background: NSCLC is frequent in elderly patients (pts), however there is limited information on the treatment of this population. This study describes the first-line treatment with bevacizumab (bev) of NSCLC elderly pts in real life in France. Methods: AVANTAGE is a non-interventional, prospective, multicenter French study conducted in pts with advanced NSCLC starting first-line chemotherapy (CT) with bev. It includes 2 cohorts, pts aged 65-70 (C1), or ≥ 70 (C2) . Data were collected at inclusion and every 3 months subsequently for 18 months. The primary objective was to describe CT used with bev in first-line in routine clinical practice. Results: A total of 249 pts were eligible (277 included) in 68 centers: 108 (43%) in C1 & 141 (57%) in C2. They were predominantly men (75%), ECOG PS 0-1 (85%) PS 2 (15%), G8 questionnaire score >14 (35%), stage IV (96%), Charlson comorbidity index unadjusted ≤2 (63%), and brain metastases identified in 18% of pts overall, 20% of pts in C2. Platinum-based doublet CT and pemetrexed (pem) was the most used combination with bev in 186 (75%) pts overall: - 81% of pts in C1 (62% cisplatin-pem and 18% carboplatin-pem) - 70% of pts in C2 (26% cisplatin-pem and 44% carboplatin-pem). The initial dose of bev with CT was 7.5 mg/kg/3 weeks in 70% of pts. Overall, maintenance treatment was administered to 61% pts, including 53% with bev (24% in monotherapy and 29% with pem). Maintenance was 64% in C1and 62% in C2. Median PFS was 7.1 months, and median OS was 12.3 months (14.9 months in C1, 11.3 months in C2). Overall, 92% of pts presented at least 1 AE. Pts with grade ≥ 3 AEs related to bev were 12% in C1 and 24% in C2. In the safety population (260), 148 pts died during the study. 3 pts (all in C2) died due to SAEs related to treatment (intestinal perforation; febrile neutropenia/septic shock/ thrombocytopenia; unknown cause). Conclusions: AVANTAGE is the 1st prospective cohort conducted in routine clinical practice in France in elderly pts eligible for 1st-line CT with bev. The most frequently used treatment was the combination of platinum-pem doublet (75% of pts). Bev effectiveness as 1st line treatment in NSCLC was consistent with the efficacy observed in clinical trials in the elderly as was the safety profile. Clinical trial identification: Clincial Trial Gov: NCT01893268. Editorial acknowledgement: Dr Samia Rahal from ELTIUM (French medical writting company). Legal entity responsible for the study: Roche S.A.S. Funding: Roche S.A.S. Disclosure: F. Lionel, D. Perol, H. Le Caer, P-J. Souquet: Payment for advisory: Roche. E. Dansin: Payment for advisory: Roche, Lilly, MSD. C. Audigier Valette: Payment for advisory: Roche, Pfizer, Boehringer Ingelheim, Lilly, AstraZeneca, Amgen, Bristol-Myers Squibb, Symex, MSD, Clovis Oncology, Novartis. J.-L. Mouysset, E. Fabre-Guillevin: Payment as study's investigator: Roche. M.L. Uffredi, M. Ionescu-Goga: Employee: Roche. K. Veerabudun, Y. Lelarge: Business partner employee: Roche.