Efficacy Of Bevacizumab Combined With Chemotherapy As First-line And Second-line Treatment In Advanced Non-squamous Non-small Cell Lung Cancer

Objective: Retrospectively analyzed the difference in efficacy of bevacizumab combined with chemotherapy in first-line,second-line and first-line and second-line cross-line treatment of advanced non-squamous non-small cells,aiming to analyze the influence of the timing of bevacizumab application on efficacy,progression-free survival and overall survival of patients.Methods: This study retrospectively collected the Cancer Hospital of China Medical University on January 1,2016 to March 31,2020 cases were complete record of the scale,a total of 99 patients with non-small cell lung cancer,and follow-up time until November30,2020,including 73 cases of patients with death,23 patients with survival,3 patients with OS lost to follow-up,PFS2 lost to follow-up in 2 cases,1 cases across the quad,1 case for a quad,median follow-up time was 45 months.Patients included had received at least two systemic chemotherapy regiments,and at least one chemotherapy regimen was combined with bevacizumab.The purpose of this study was to compare the combined treatment effect of bevacizumab and chemotherapy with previous single chemotherapy,and the groups were as follows: the combined treatment of bevacizumab was only applied to patients in the first-line chemotherapy stage as a one-line group.The combination therapy of bevacizumab was only used in the second-line chemotherapy group.A cross-line group was also set,that is,bevacizumab was used in combination with both first-line and second-line treatments.And to three groups of efficacy relative comparison.Multivariate factors affecting the efficacy were collected for univariate and multivariate analysis.The primary endpoints were overall survival(OS)and progression-free survival(PFS).Secondary study endpoints were objective response rate(ORR)and disease control rate(DCR).PFS1 refers to the time period from the beginning of first-line treatment to the end of first-line treatment progression,and PFS2 refers to the time period from the beginning of second-line treatment to the end of second-line treatment progression or to the end of patient death due to all causes.The cumulative PFS was PFS1+PFS2.The time between the start of first-line treatment and death from any cause was also set to OS.SPSS25.0 software was used for statistical analysis of data,Kaplan-Meier method was used to calculate the survival rate,log-rank was used to compare the survival rate between groups,chi-square test was used for comparison of data between groups,and Cox regression model was used for multivariate analysis.P <0.05 was considered statistically significant.Results:The median age of the 99 patients included in the study was 58 years,including57 male patients,accounting for 57.6%.Eighty-four patients(84.8%)had ECOG score≤1.66 patients were treated with bevacizumab in first-line treatment,and 23 patients were also treated with bevacizumab in second-line treatment.Fifty-six patients received second-line treatment combined with bevacizumab,including 23 patients who also received first-line treatment with bevacizumab.The cumulative median PFS and median OS were 13.3(95%CI 11.69-14.91)months and 19.0(95%CI 15.77-22.23)months,respectively.In first-line treatment,patients with chemotherapy combined with bevacizumab(n=66)and chemotherapy alone(n=33)had median PFS1 of 7.7(95%CI6.41-8.99)months and 5.5(95%CI 3.91-7.01)months,respectively(P<0.05).ORR were69.7% and 36.4%(P<0.05),respectively.DCR were 98.5% and 87.9%(P<0.05),respectively.In the second-line treatment,the median PFS2 in patients with chemotherapy combined with bevacizumab(n=56)and chemotherapy alone(n=43)was6.4(95%CI 4.89-7.91)months and 4.6(95%CI 4.37-6.83)months,respectively(P<0.05).ORR were 35.7% and 14.0%(P<0.05),respectively.DCR were 91.9% and 72.1% respectively(P < 0.05),in the second line of beacizumab bead sheet resistance according to the first line therapy in patients with beacizumab bead is used only in the subgroup analysis of resistance,two groups of the median PFS2 were 6.4(95% CI 2.76 10.04)and6.0(95% CI 4.29 7.71)months,there was no statistically significant difference(P =0.717),the joint beacizumab bead sheet resistance to first-line chemotherapy in patients according to whether the joint beacizumab bead in second-line treatment only in the subgroup analysis of resistance,The median PFS2 in the two groups was 6.4(95%CI2.76-10.04)months and 4.6(95%CI 3.78-5.45)months,respectively,and the difference was statistically significant(P=0.003).The median cumulative PFS of the first-line group(n=43),second-line group(n=33)and cross-line group(n=23)was 13.9(95%CI11.94-15.86)months,12.4(95%CI 8.87-15.93)months and 17.9(95%CI 10.67-25.13) months,respectively,without statistical significance(P=0.297).The median OS was 18.7(95%CI 15.89-21.51)months,20.6(95%CI 15.16-26.04)months,and 20.2(95%CI16.76-23.64)months,respectively,and the difference was still not statistically significant(P=0.688).Conclusion: Retrospective analysis results showed that bevacizumab combined with chemotherapy prolonged median PFS,DCR,and ORR compared with chemotherapy alone.First-line bevacizumab had no significant effect on the survival of second-line bevacizumab patients.After the first-line treatment with bevacizumab progressed,the benefit of PFS2 remained after the second-line treatment with bevacizumab.The timing of bevacizumab application had no significant effect on cumulative PFS and OS.