Real-world Study Of Bevacizumab In First-line Treatment Of Advanced Non-small Cell Lung Cancer

Purpose: To evaluate the efficacy and safety of bevacizumab in combination with targeted therapy,combination chemotherapy,and participation in maintenance therapy for advanced non-small cell lung cancer in the real world.Methods:A retrospective collection of 180 patients with advanced(stage IIIB-IV)non-small cell lung cancer diagnosed in the xx region between May 2014 and December2022 was divided into a bevacizumab group(n=80)and a non-bevacizumab group(n=100)according to whether bevacizumab was added to first-line therapy.Among them,116 cases were in the EGFR-TKI group(87 cases in the first-generation TKI,15 cases in the second-generation TKI,and 14 cases in the third-generation TKI;64 cases in the chemotherapy group.The efficacy evaluation criteria for solid tumors,version 1.1(RECIST 1.1)and the National Cancer Institute Common Toxicity Criteria(NCI-CTC5.0)were used as the reference standards for efficacy and safety assessment.The primary study endpoints were progression-free survival(PFS)and overall survival(OS);the secondary study endpoints were objective response rate(ORR),disease control rate(DCR),and survival.The secondary study endpoints were objective response rate(ORR),disease control rate(DCR)and OS rate,and treatment-related adverse events for all patients.Results:1.In overall patients,median PFS was significantly prolonged in the bevacizumab group compared with the non-bevacizumab group(18.9 months vs 12.3months,P=0.002),but median OS was not prolonged(36.6 months vs 45.3 months,P=0.440).2.Among patients treated with EGFR-TKIs in first line,median PFS was significantly prolonged in the overall TKIs + bev group compared with the TKIs monotherapy group(20.9 months vs 13.5 months,P=0.007),but median OS was not prolonged(40.3months vs 47.6 months,P=0.544);among them,median PFS was significantly prolonged in the first-generation TKIs + bev group compared with the first-generation TKIs alone(21.1 months vs.13.5 months,P=0.017),but not median OS(43.7 months vs.46.7 months,P=0.913),with a trend toward improved ORR(75.0% vs.58.7%)and DCR(100% vs.98.4)in the first-generation TKIs+Bev group but not statistically different.Median PFS(24.8 months vs 21.1 months,P=0.511)and median OS(not reached vs 43.7 months,P=0.664)were not significantly different between the second-generation TKIs+Bev group and the first-generation TKIs+Bev group;compared with the third-generation TKIs single-agent group,median PFS in the third-generation TKIs+Bev group(19.1 months vs 19.2 months,P=0.758),and median OS(36.6 months vs.not achieved,P=0.737)were not improved in the third-generation TKIs+Bev group compared with the third-generation TKIs single-agent group.Patients who developed T790 M mutations after progression on first-line therapy with first-generation TKIs + bevacizumab showed no prolongation in median PFS(9.8months vs 17.0 months,P=0.420)and median OS(32.0 months vs 43.7 months,P=0.781)in the second-line therapy with the third-generation TKIs oxitinib +bevacizumab group compared with the oxitinib monotherapy group.3.In patients treated with platinum-containing double-agent first-line chemotherapy,median PFS was prolonged by 7.5 months in the chemotherapy + bev group compared with the chemotherapy alone group(23.3 months vs 15.8 months,P=0.054),but there was no statistical difference;median OS(35.1 months vs 34.2 months,P=0.723)and ORR(53.1% vs 37.5%,P=0.209)also increased,but there was no statistical difference.Among patients treated with bevacizumab as maintenance therapy,there was a prolongation of median PFS(18.9 months vs 16.5 months,P=0.395)and median OS(49.0 months vs 20.1 months,P=0.511)in the bevacizumab combined with pemetrexed maintenance group compared with the bevacizumab monotherapy maintenance group,but there was no statistical difference.4.There was no significant difference in the incidence of adverse events between the bevacizumab and non-bevacizumab groups(43.8% vs 46.0%,P=0.763),and the incidence of grade 3 or higher adverse events was similar(12.5% vs 10.0%,P=0.596).5.The use of bevacizumab was an independent prognostic factor for PFS(HR=0.620,95% CI: 0.442-0.869,P=0.006).Conclusion: In the real world,bevacizumab as first-line treatment for advanced non-squamous non-small cell lung cancer resulted in significantly longer PFS without increasing the incidence of serious adverse events in patients.