Departments of Oncology.
Internal Medicine, Montefiore Medical Center.
Am J Clin Oncol. 2020 Jan;43(1):64-68. doi: 10.1097/COC.0000000000000628.
Bevacizumab with chemotherapy improved overall survival (OS) in the E4599 trial in metastatic nonsquamous non-small cell lung cancer (NS-NSCLC). A meta-analysis demonstrated an OS benefit with bevacizumab only in a subset of nonwhite patients. We explored the efficacy of antivascular endothelial growth factor antibodies (AVA) in a diverse cohort.
Patients with advanced (stage IIIB/IV, American Joint Committee Cancer 7th edition) recurrent or metastatic NS-NSCLC diagnosed January 2006 to December 2017 at a single medical center were included. Survival analysis was performed with log-rank testing of the Kaplan-Meier estimator. Univariate models were constructed, and significant variables, age, sex, race were incorporated into a multivariate Cox proportional hazard model. Data analysis was performed on SAS.
A total of 171 patients, 80 were treated with AVA and 91 were untreated. Median age: 63 years, 55% females, 19% non-Hispanic whites, 44% blacks and 32% Hispanic whites; median 40 pack-years of smoking; 11.7% had sensitizing epidermal growth factor receptor mutations. Patients who received AVA had a survival benefit (26.6 vs. 19 mo, P=0.025). Adjusting for age, sex, race/ethnicity, epidermal growth factor receptor mutations, Eastern Cooperative Oncology Group performance status and number of metastases; AVA therapy was associated with improved OS (adjusted hazard ratio=0.62; P=0.049). In a subgroup analysis, females had survival benefit with AVA (median survival: 29.1 vs. 14.2 mo, log-rank P=0.02) which was significant in the adjusted model (adjusted hazard ratio=0.52; P=0.049).
In a diverse cohort of patients with advanced NS-NSCLC, a survival benefit was confirmed with AVA. The greatest magnitude of benefit was in blacks and non-Hispanic whites. A significant survival benefit was limited to female patients.
贝伐珠单抗联合化疗可提高转移性非鳞状非小细胞肺癌（NS-NSCLC）E4599 试验中的总生存期（OS）。一项荟萃分析显示，贝伐珠单抗仅在非白人患者亚组中具有 OS 获益。我们在一个多样化的队列中探讨了抗血管内皮生长因子抗体（AVA）的疗效。
纳入 2006 年 1 月至 2017 年 12 月在单一医疗中心诊断为晚期（IIIb/IV 期，美国癌症联合委员会第 7 版）复发性或转移性 NS-NSCLC 的患者。采用 Kaplan-Meier 估计值的对数秩检验进行生存分析。构建单变量模型，并将年龄、性别、种族等显著变量纳入多变量 Cox 比例风险模型。数据分析在 SAS 上进行。
共纳入 171 例患者，80 例接受 AVA 治疗，91 例未接受 AVA 治疗。中位年龄为 63 岁，55%为女性，19%为非西班牙裔白人，44%为黑人，32%为西班牙裔白人；中位吸烟 40 包年；11.7%有敏感表皮生长因子受体突变。接受 AVA 治疗的患者具有生存获益（26.6 个月比 19 个月，P=0.025）。调整年龄、性别、种族/民族、表皮生长因子受体突变、东部肿瘤协作组表现状态和转移灶数量后；AVA 治疗与 OS 改善相关（调整后的风险比=0.62；P=0.049）。在亚组分析中，女性使用 AVA 具有生存获益（中位生存时间：29.1 个月比 14.2 个月，log-rank P=0.02），在调整模型中具有统计学意义（调整后的风险比=0.52；P=0.049）。
在一个多样化的晚期 NS-NSCLC 患者队列中，AVA 治疗确实具有生存获益。黑人及非西班牙裔白人获益最大。女性患者的生存获益具有显著意义。
