Long Qianqian, Feng Yu, Liu Chang, Wu Xianghua, Wang Huijie, Yu Hui, Zhao Xinmin, Wang Jialei
Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Ann Transl Med. 2020 Oct;8(20):1311. doi: 10.21037/atm-20-6327.
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).
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.
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.
Bev, in combination with the front-line chemotherapy, is proven beneficial for survival well-tolerated.
贝伐单抗联合铂类化疗已被批准用于无驱动基因的晚期非鳞状非小细胞肺癌（NSCLC）的一线治疗，但该方案用于非鳞状NSCLC的二线或后续治疗仍有待进一步验证。我们的研究旨在提供中国真实世界临床常规实践中不同线别情况下含贝伐单抗（Bev）化疗对NSCLC患者的安全性和有效性数据，并探索无进展生存期（PFS）和总生存期（OS）的预测因素。
我们回顾了2009年12月至2020年1月期间在上海复旦大学附属肿瘤医院接受Bev联合化疗作为一线、二线或三线及后续治疗的194例非鳞状NSCLC患者的病历。对每位患者的临床特征、治疗史、临床评估和不良反应进行了深入分析。采用Kaplan-Meier法估计PFS和OS。进行单因素和多因素分析以寻找更长PFS和OS的预测因素。
194例患者纳入本研究，其中分别有102例（52.6%）、58例（29.9%）和34例（17.5%）患者接受Bev联合一线化疗（Bev+Che1）、二线化疗（Bev+Che2）和三线/后续化疗（Bev+Che3）。Bev联合一线化疗及化疗疗程>6个是PFS显著延长的独立预测因素。然而，65岁以上或ECOG PS≥2的患者与二线/后续化疗相比，在一线化疗中加用Bev可能并无更多获益。在化疗疗程>6个的Bev队列中，接受或未接受化疗作为维持治疗的患者的PFS无显著差异（P=0.354）。至于OS，Bev联合一线化疗及转移部位数<3个是独立预测因素。最常见的不良反应（AE）为白细胞减少、中性粒细胞减少、高血压和蛋白尿。20例患者发生≥3级AE。
Bev联合一线化疗被证明对生存有益且耐受性良好。
