Comparison Of Efficacy Between The Immunotherapy Or Bevacizumab Combined With Chemotherapy In First-line Treatment Of Advanced Non-squamous Non-Small Cell Lung Cancer

ObjectiveIn this retrospective study,(1)without considering PD-L1 expression,to explore the efficacy difference of immunochemotherapy or bevacizumab combined with chemotherapy in the first-line treatment of advanced non-squamous non-small cell lung cancer with negative driver gene;(2)to explore the difference in efficacy between first-line immunization combined with chemotherapy and bevacizumab combined with chemotherapy in the treatment of patients with advanced non-squamous NSCLC with negative driver gene at different PD-L1 expression patients.Through retrospective analysis,the optimal partner of chemotherapy in the first-line treatment of advanced driver gene-negative non-squamous NSCLC will be clarified,which providing a reference for the selection of first-line treatment regimens in our clinical work.MethodA total of 176 patients who were selected from a third-class A hospital in Nanchang city from August 2017 to September 2021 were diagnosed with advanced non-squamous NSCLC without EGFR,ALK,or ROS-1 mutations,and any previous treatment,receiving first-line immunotherapy combined with chemotherapy or bevacizumab combined with chemotherapy for ≥2 courses.The immune combined chemotherapy group(set as group A)and the bevacizumab combined chemotherapy group(set as group B),including 92 cases in group A(52.3%)and 84 cases in group B(47.7%).Relevant influencing factors such as age,gender,smoking history,PS score,basic disease,metastatic site,the number of metastatic sites were analyzed by Kaplan-Meier method,Fisher’s exact test and Cox regression in SPSS software,and set at P<0.05,which was statistically significant.The differences in PFS,ORR and DCR between the immune combined chemotherapy group and the bevacizumab combined chemotherapy group were compared,and whether the expression of different PD-L1 would affect the efficacy of the two first-line treatments were analyzed through subgroup analysis.ResultsRegardless of PD-L1 expression,the combined immunotherapy group extended median PFS(10.5 months vs.9.4 months P<0.001),and the cumulative risk of death was also higher in the bevacizumab plus chemotherapy group than in the immunotherapy group.Between ORR and DCR,immunization combined with chemotherapy was also more dominant,although P value was not statistically significant.Through Cox univariate and multivariate analysis,the positive PD-L1 expression,no liver metastasis,and the number of metastatic sites ≤2 were independent influencing factors for better PFS in patients.According to the subgroup analysis of PD-L1 expression,it was found that in both the PD-L1 positive group and the PD-L1 negative group,the combined immunotherapy group could prolong PFS.In the PD-L1 negative group,the combined immunotherapy group compared with the bevacizumab combined treatment group,m PFS extended 0.4months(9.7 months vs9.3 months,P=0.049);In the PD-L1 positive group,m PFS were 1.7 months longer in the immunotherapy group than in the bevacizumab group(11.2 months vs 9.5 months,P=0.003).ConclusionIn the first-line treatment of patients with advanced non-squamous non-small cell lung cancer lacking driver mutations,immune-combination chemotherapy still holds a greater advantage over bevacizumab combination chemotherapy,which further demonstrating the importance of immune-combination chemotherapy,especially for PD-L1 expression-positive patients.