Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo, 113-8677, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 105-0045, Japan.
J Cancer Res Clin Oncol. 2019 Oct;145(10):2555-2564. doi: 10.1007/s00432-019-02985-1. Epub 2019 Jul 26.
Previously, the combination of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and bevacizumab (BEV) was investigated. A subgroup analysis of the IMpower150 trial, which investigated the combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab (ABCP), demonstrated the benefit of ABCP in patients harboring EGFR mutations. This study aims to assess the prognostic significance of the qualification for BEV use and the proportion of patients who potentially benefit from BEV-containing combination therapy before and after initial EGFR-TKI treatment.
We retrospectively analyzed the data of 297 patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) harboring EGFR mutations who had received EGFR-TKIs. We performed statistical analyses using the Kaplan-Meier method and the Cox regression adjusted for risk factors.
Of the 297 patients, 203 (68%) were eligible to receive BEV ("BEV fit") at the time of EGFR-TKI initiation. Among the "BEV unfit" patients at baseline (n = 70), 14 (20%) became eligible to receive ABCP ("ABCP fit") at the time of EGFR-TKI failure. The median overall survival (OS) of the "BEV fit" and "BEV unfit" patients was 26.2 [95% confidence interval (CI) 23.7-31.2] and 19.1 (95% CI 15.0-25.1) months, respectively (P < 0.001). The multivariate analysis revealed a marked correlation between survival and the qualification for BEV use.
The qualification for BEV use at baseline is independently related to the OS. Some patients harboring EGFR mutations, including those who were "BEV unfit" at baseline, could be eligible for the ABCP regimen after EGFR-TKI treatment.
先前研究了表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）与贝伐珠单抗（BEV）联合治疗。IMpower150 试验的一项亚组分析显示，在携带 EGFR 突变的患者中，阿特珠单抗联合卡铂、紫杉醇和 BEV（ABCP）的方案具有获益。本研究旨在评估 EGFR-TKI 治疗前和治疗后符合 BEV 使用条件的比例以及可能从 BEV 联合治疗中获益的患者比例的预后意义。
我们回顾性分析了 297 例接受 EGFR-TKI 治疗的携带 EGFR 突变的晚期或复发性非鳞状非小细胞肺癌（NSCLC）患者的数据。采用 Kaplan-Meier 法和 Cox 回归分析调整风险因素进行统计学分析。
在 297 例患者中，203 例（68%）在开始 EGFR-TKI 治疗时符合 BEV 使用条件（“BEV 适合”）。在基线时不符合 BEV 使用条件的 70 例患者中（n=70），有 14 例（20%）在 EGFR-TKI 失败时符合 ABCP 使用条件（“ABCP 适合”）。“BEV 适合”和“BEV 不适合”患者的中位总生存期（OS）分别为 26.2 [95%置信区间（CI）：23.7-31.2]和 19.1 个月（95% CI：15.0-25.1）（P<0.001）。多变量分析显示，生存与 BEV 使用资格之间存在显著相关性。
基线时符合 BEV 使用条件与 OS 显著相关。一些携带 EGFR 突变的患者，包括基线时不符合 BEV 使用条件的患者，在 EGFR-TKI 治疗后可能有资格接受 ABCP 方案。
