Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer

The different overall survival between single-agent EGFR-TKI treatment and with bevacizumab in non-small cell lung cancer patients with brain metastasis

Comparison of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) monotherapy or with bevacizumab in real-world non-small cell lung cancer (NSCLC) patients was lacking. 310 patients of advanced NSCLC with common EGFR mutation receiving first-generation EGFR-TKI monotherapy or with bevacizumab were included and propensity-score matched. Progression-free survival (PFS), overall survival (OS) and secondary T790M mutation were analysed. Patients receiving EGFR-TKI and bevacizumab were significantly younger, had better performance status and with high incidence of brain metastasis (55.8%). In the propensity-score matched cohort, PFS (13.5 vs. 13.7 months; log-rank p = 0.700) was similar between the two groups. The OS (61.3 vs. 34.2 months; log-rank p = 0.010) and risk reduction of death (HR 0.42 [95% CI 0.20–0.85]; p = 0.017) were significantly improved in EGFR-TKI plus bevacizumab group. Analysis of treatment by brain metastasis status demonstrated EGFR-TKI plus bevacizumab in patients with brain metastasis was associated with significant OS benefit compared to other groups (log-rank p = 0.030) and these patients had lower early-CNS and early-systemic progressions. The secondary T790M did not significantly differ between EGFR-TKI plus bevacizumab and EGFR-TKI monotherapy groups (66.7% vs. 75.0%, p = 0.460). Forty-one (31.1%) and 31 (23.5%) patients received subsequent osimertinib and chemotherapy, respectively. The post-progression OS of osimertinib and chemotherapy were 22.1 and 44.9 months in EGFR-TKI plus bevacizumab group and were 10.0 and 14.1 months in EGFR-TKI monotherpay group, respectively. First-generation EGFR-TKI with bevacizumab improved treatment efficacy in real-world patients of NSCLC with EGFR mutation. Patients with brain metastasis received additional OS benefit from this treatment.

The optimal timing and courses of bevacizumab added to chemotherapy for non-squamous non-small cell lung cancer: revelations from the real-world experience in a single Chinese cancer center

Background

Bevacizumab combined with platinum-based chemotherapy has been approved in the first-line treatment for advanced non-squamous non-small cell lung cancer (NSCLC) without driver genes, but this regimen for second-line or later-line treatment of non-squamous NSCLC remains to be further tested. Our study aimed to provide data on the safety and effectiveness of bevacizumab (Bev)-containing chemotherapy in different-line settings for patients with NSCLC in the Chinese real-world clinical routine practice and to explore predictors for progression-free survival (PFS) and overall survival (OS).

Methods

We reviewed the medical records of 194 patients with non-squamous NSCLC who received Bev plus chemotherapy as the first-, second- or third- or later-line treatment between December 2009 and January 2020 at Fudan University, Shanghai Cancer Center. Clinical characteristics, treatment history, clinical evaluation, and adverse effects of each patient were deeply analyzed. PFS and OS were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were conducted to find predictors of longer PFS and OS.

Results

One hundred ninety-four patients were enrolled in this study, including 102 (52.6%), 58 (29.9%) and 34 (17.5%) patients received Bev in combination with the first-line chemotherapy (Bev + Che1), second-line chemotherapy (Bev + Che2) and third-/later-line chemotherapy (Bev + Che3), respectively. Administration of Bev in combination with the first-line chemotherapy and >6 courses were independent predictors of significantly prolonged PFS. Whereas, patients older than 65 years or with ECOG PS ≥2 may not benefit more from Bev added to the first-line chemotherapy compared to second-/later-line chemotherapy. PFS of patients received treatment with/without chemotherapy as maintenance therapy showed no significant difference (P=0.354) in >6 courses Bev cohort. As for OS, Bev plus the first-line chemotherapy and number of metastatic sites <3 were independent predictors. The most common adverse effects (AE) were leukopenia, neutropenia, hypertension, and proteinuria. Twenty patients suffered from AE ≥ Grade 3.

Conclusions

Bev, in combination with the front-line chemotherapy, is proven beneficial for survival well-tolerated.

The Combination of Afatinib and Bevacizumab in Untreated EGFR-Mutated Advanced Lung Adenocarcinoma: A Multicenter Observational Study

The efficacy of afatinib in combination with bevacizumab in untreated advanced epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma is currently unclear. We sought to investigate the efficacy of this combination through a multicenter observational analysis. Data for 57 patients with advanced EGFR-mutated lung adenocarcinoma who received afatinib combined with bevacizumab as first-line therapy at the Chang Gung Memorial Hospitals in Linkou and Kaohsiung and Taipei Tzu Chi Hospital from May 2015 to July 2019 were analyzed. The objective response rate and disease control rate of afatinib combined with bevacizumab therapy were 87.7% and 100%, respectively. In all patients, the median progression-free survival (PFS) and overall survival (OS) were 23.9 (95% confidence interval (CI) (17.56–29.17)) and 45.9 (95% CI (39.50–53.60)) months, respectively. No statistical significance between exon 19 deletion and L858R mutations was noted in PFS or OS. The most frequent adverse events (AEs) were diarrhea (98.2%) and dermatitis (96.5%), and most AEs were grade 2 or lower and manageable. The combination of afatinib and bevacizumab is an effective therapy for untreated advanced EGFR-mutated lung adenocarcinoma with acceptable safety. Future prospective studies focusing on this combination for untreated advanced EGFR-mutated lung adenocarcinoma are warranted.