表皮生长因子受体酪氨酸激酶抑制剂联合贝伐珠单抗对比表皮生长因子受体酪氨酸激酶抑制剂单药治疗表皮生长因子受体突变阳性的晚期非小细胞肺癌：倾向评分匹配分析。
EGFR-TKI plus bevacizumab versus EGFR-TKI monotherapy for patients with EGFR mutation-positive advanced non-small cell lung cancer-A propensity score matching analysis.
机构信息
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
出版信息
J Formos Med Assoc. 2021 Sep;120(9):1729-1739. doi: 10.1016/j.jfma.2021.03.023. Epub 2021 Apr 14.
BACKGROUND
Recent study showed that the combination of erlotinib and bevacizumab had better disease control than erlotinib monotherapy in patients with advanced epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). However, there is lack of real-world evidence for this therapeutic regimen. We aimed to compare outcomes between patients with EGFR mutant NSCLC treated with EGFR-tyrosine kinase inhibitors (TKI) and bevacizumab and those treated with EGFR-TKI alone in a real-world setting.
METHODS
Patients with advanced EGFR-mutant NSCLC who received first-line EGFR-TKI in a tertiary referral center from October 1, 2013 to December 31, 2019 were retrospectively analyzed. We performed 1:2 propensity score-matching: one EGFR-TKI and bevacizumab recipient with two patients who received EGFR-TKI alone. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. The prognostic factors were analyzed using Cox proportional hazards regression analysis.
RESULTS
Total 313 patients were enrolled. After propensity score matching, 45 patients who received first-line EGFR-TKI and bevacizumab and 89 patients who received EGFR-TKI alone were analyzed. The combination group showed improved PFS (17.0 vs. 11.0 months; hazard ratio [HR] = 0.48; p = 0.002) compared to the monotherapy group. In subgroup analysis of patients with an L858R mutation, the combination group showed longer PFS (23.1 vs. 10.7 months; HR = 0.40; p = 0.011) and OS (not reached vs. 40.6 months; HR = 0.27; p = 0.040) than the EGFR-TKI monotherapy group.
CONCLUSION
Our data suggest that the combination of EGFR-TKI and bevacizumab could improve PFS in patients with EGFR-mutant NSCLC. In patients harboring L858R mutation, the combination therapy provides better OS than TKI alone.
背景
最近的研究表明，厄洛替尼联合贝伐珠单抗治疗晚期表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）患者的疾病控制效果优于厄洛替尼单药治疗。然而，这种治疗方案缺乏真实世界的数据。我们旨在比较 EGFR 突变型 NSCLC 患者接受 EGFR 酪氨酸激酶抑制剂（TKI）联合贝伐珠单抗与单独接受 EGFR-TKI 治疗的结局。
方法
回顾性分析 2013 年 10 月 1 日至 2019 年 12 月 31 日在一家三级转诊中心接受一线 EGFR-TKI 治疗的晚期 EGFR 突变型 NSCLC 患者。我们进行了 1:2 的倾向评分匹配：将接受 EGFR-TKI 和贝伐珠单抗的 1 例患者与单独接受 EGFR-TKI 的 2 例患者进行匹配。采用 Kaplan-Meier 法评估无进展生存期（PFS）和总生存期（OS）。采用 Cox 比例风险回归分析评估预后因素。
结果
共纳入 313 例患者。经倾向评分匹配后，分析了 45 例接受一线 EGFR-TKI 联合贝伐珠单抗和 89 例接受 EGFR-TKI 单药治疗的患者。与单药组相比，联合组的 PFS（17.0 个月比 11.0 个月；风险比[HR] 0.48；p = 0.002）得到改善。在 L858R 突变患者的亚组分析中，联合组的 PFS（23.1 个月比 10.7 个月；HR 0.40；p = 0.011）和 OS（未达到比 40.6 个月；HR 0.27；p = 0.040）均长于 EGFR-TKI 单药组。
结论
我们的数据表明，EGFR-TKI 联合贝伐珠单抗可改善 EGFR 突变型 NSCLC 患者的 PFS。在携带 L858R 突变的患者中，联合治疗的总生存期优于 TKI 单药治疗。
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