Department of Pulmonary and Critical Care Medicine, Peking Union Medical Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
Thorac Cancer. 2020 Jul;11(7):1869-1875. doi: 10.1111/1759-7714.13469. Epub 2020 May 14.
Pemetrexed and bevacizumab as monotherapies, or in combination, have been approved for maintenance therapy following platinum-based induction in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). The differences in the benefits of bevacizumab for treatment during early or late NSCLC have not yet been characterized.
We retrospectively analyzed data from 35 patients with advanced naïve NSCLC who had received pemetrexed/platinum with or without bevacizumab followed by maintenance therapy with pemetrexed alone or pemetrexed plus bevacizumab. The data were analyzed using the Kaplan-Meier method and Cox regression adjusted for risk factors. Patients were grouped according to treatment conditions. Group A received pemetrexed plus platinum followed by pemetrexed alone (Pem-Pt/Pem). Group B received pemetrexed plus platinum followed by pemetrexed and bevacizumab (Group B; Pem-Pt/Pem + Bev). Group C received pemetrexed, platinum, and bevacizumab during induction therapy, and pemetrexed as maintenance therapy (Group C; Pem-Pt + Bev/Pem + Bev). We assessed the significance of introduction of bevacizumab at different stages of treatment.
A total of 13 (37.1%) patients were included in Group A, nine patients (25.7%) were included in Group B, and 13 patients (37.1%) were included in Group C. Among the 35 patients, 69.2% were male, and the median age was 59 years (range 40-75). The median progression-free survival (PFS) was 7.7 months (231 days, range 134-410 days) in Group A, 9.3 months (280 days, range 84-565 days) in Group B, and 8.0 months (241 days, range 108-665 days) in Group C. The median PFS was not significantly different among the three groups (P = 0.233). Similarly, bevacizumab did not significantly affect PFS (P = 0.630).
The addition of bevacizumab into induction chemotherapy or maintenance therapy provided limited benefits to PFS in our study, but previous studies suggested that bevacizumab may improve disease control. In that way, we presume that early use of bevacizumab may provide a greater benefit.
培美曲塞和贝伐珠单抗作为单药治疗或联合治疗，已被批准用于铂类诱导后晚期非鳞状非小细胞肺癌（NSCLC）患者的维持治疗。贝伐珠单抗在早期或晚期 NSCLC 治疗中的获益差异尚未明确。
我们回顾性分析了 35 例接受培美曲塞/铂类联合或不联合贝伐珠单抗诱导治疗后接受培美曲塞单药或培美曲塞联合贝伐珠单抗维持治疗的初治晚期 NSCLC 患者的数据。采用 Kaplan-Meier 法和 Cox 回归分析调整风险因素。根据治疗情况将患者分为 3 组：A 组接受培美曲塞联合铂类，然后接受培美曲塞单药治疗（Pem-Pt/Pem）；B 组接受培美曲塞联合铂类，然后接受培美曲塞联合贝伐珠单抗治疗（Pem-Pt/Pem+Bev）；C 组接受培美曲塞、铂类和贝伐珠单抗诱导治疗，培美曲塞维持治疗（Pem-Pt+Bev/Pem+Bev）。我们评估了不同治疗阶段引入贝伐珠单抗的意义。
共纳入 13 例（37.1%）患者入组 A 组，9 例（25.7%）患者入组 B 组，13 例（37.1%）患者入组 C 组。35 例患者中，69.2%为男性，中位年龄为 59 岁（范围 40-75 岁）。A 组中位无进展生存期（PFS）为 7.7 个月（231 天，范围 134-410 天），B 组为 9.3 个月（280 天，范围 84-565 天），C 组为 8.0 个月（241 天，范围 108-665 天）。三组间中位 PFS 无显著差异（P=0.233）。同样，贝伐珠单抗对 PFS 无显著影响（P=0.630）。
在本研究中，培美曲塞联合贝伐珠单抗诱导化疗或维持治疗对 PFS 的获益有限，但之前的研究表明，贝伐珠单抗可能改善疾病控制。因此，我们推测早期使用贝伐珠单抗可能会带来更大的获益。
