Open Access Research article

Early dissemination of bevacizumab for advanced colorectal cancer: a prospective cohort study

S Yousuf Zafar12*, Jennifer L Malin34, Steven C Grambow25, David H Abbott2, Deborah Schrag6, Jane T Kolimaga27, Leah L Zullig28, Jane C Weeks9, Mona N Fouad10, John Z Ayanian11, Robert Wallace12, Katherine L Kahn13, Patricia A Ganz14, Paul Catalano15, Dee W West16, Dawn Provenzale27 and the Cancer Care and Outcomes Research and Surveillance (CanCORS) Consortium

Author Affiliations

1 Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

2 Center for Health Services Research in Primary Care, DDurham VA Medical Center, Durham, NC, USA

3 Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA

4 Division of Hematology and Medical Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

5 Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

6 Dana-Farber Cancer Institute, Boston, MA, USA

7 Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

8 University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, NC, USA

9 Department of Health Policy and Management, Dana Farber Cancer Institute, Boston, MA, USA

10 Division of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

11 Department of Health Care Policy, Harvard Medical School, and Division of General Medicine, Brigham and Women's Hospital Boston, MA, USA

12 Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA

13 RAND Corporation, Santa Monica, CA; and Divisions of General Internal Medicine & Health Services Research, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA

14 School of Public Health, University of California, Los Angeles, CA, USA

15 Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA, USA

16 Northern California Cancer Center, Fremont, CA; and Stanford School of Medicine, Stanford, CA, USA

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BMC Cancer 2011, 11:354  doi:10.1186/1471-2407-11-354

Published: 16 August 2011

Abstract

Background

We describe early dissemination patterns for first-line bevacizumab given for metastatic colorectal cancer treatment.

Methods

We analyzed patient surveys and medical records for a population-based cohort with metastatic colorectal cancer treated in multiple regions and health systems in the United States (US). Eligible patients were diagnosed with metastatic colorectal cancer and initiated first-line chemotherapy after US Food & Drug Administration (FDA) bevacizumab approval in February 2004. First-line bevacizumab therapy was defined as receiving bevacizumab within 8 weeks of starting chemotherapy for metastatic colorectal cancer. We evaluated factors associated with first-line bevacizumab treatment using logistic regression.

Results

Among 355 patients, 31% received first-line bevacizumab in the two years after FDA approval, including 26% of men, 41% of women, and 16% of those ≥ 75 years. Use rose sharply within 6 months after FDA approval, then plateaued. 20% of patients received bevacizumab in combination with irinotecan; 53% received it with oxaliplatin. Men were less likely than women to receive bevacizumab (adjusted OR 0.55; 95% CI 0.32-0.93; p = 0.026). Patients ≥ 75 years were less likely to receive bevacizumab than patients < 55 years (adjusted OR 0.13; 95% CI 0.04-0.46; p = 0.001).

Conclusions

One-third of eligible metastatic colorectal cancer patients received first-line bevacizumab shortly after FDA approval. Most patients did not receive bevacizumab as part of the regimen used in the pivotal study leading to FDA approval.