Carboplatin, paclitaxel and bevacizumab versus cisplatin and pemetrexed for non-small cell lung cancer

Objective: To compare the safety and cost-effectiveness of carboplatin, paclitaxel and bevacizumab based chemotherapy (CPB) versus cisplatin and pemetrexed (CP). Method: A retrospective observational study (January 2009-December 2012). We included patients with non-squamous NSLC who were treated with first line CPB or CP regimens. The variables collected were: patients baseline characteristics, medical history, prognostic factors, and those concerning treatment and toxicity. The effectiveness was assessed as Response Rate (RR), Progression-Free Survival (PFS) and the Overall Survival (OS). ADR were classified according to the CTCAE criteria (Common Terminology Criteria for Adverse Events). We estimated the average cost of the first chemotherapy cycle and supportive therapy. Results: We included 36 patients, 13 treated with CPB and 23 with CP. Both groups had similar age, functional status, histology and EGFR mutations, (epidermal growth factor receptor). The rate of never-smoker patients was higher in the CPB group (46% vs. 8.7%), and of brain metastases in the CP (34.7% vs. 23%), though the latter was not significant. CPB was associated with increased risk of epistaxis, hypertension and fatigue (p < 0.05). CP was associated with a higher non-significant emetogenic toxicity incidence. There was no difference in hospitalization requirement, transfusions, supportive therapy, or death due to toxicity. There were no significant differences in the RR or PFS, though there was a statistically non-significant trend towards CPB in OS (54 vs. 23 weeks, p = 0.12). The average cost of the first chemotherapy cycle with CPB was 3.476 ±510 euros, compared to 2.218 ±154.2 euros of CP. The average cost of supportive therapy was 193.65 ±186.33 euros for CPB and 193.9 ±3.57 euros for CP. Conclusions: Our outcomes reported a similar toxicity profile between CPB and CP, except for certain ADR in one or another group, and suggested a possible superiority for CPB regimen regarding to the efficacy, though at a higher cost