Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China.
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, People's Republic of China.
Clin Transl Oncol. 2024 Aug;26(8):1968-1975. doi: 10.1007/s12094-024-03418-3. Epub 2024 Mar 13.
This study aimed to determine whether the combined use of bevacizumab could improve overall survival (OS) in patients with brain metastasis (BM), epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) undergoing cerebral radiotherapy.
A total of 237 patients with EGFR-mutant lung adenocarcinoma and BM met the inclusion criteria for this retrospective study, including 102 patients in the bevacizumab treatment group and 135 in the non-bevacizumab group. The Kaplan-Meier method was used for survival analysis. Univariate and multivariate analyses were performed to identify EGFR-mutated BM prognostic factors for these patients.
At the end of the last follow-up period, 176 patients (74.3%) had died, and the median overall survival (OS) was 34.2 months. We observed a significant difference in the median OS between the bevacizumab and non-bevacizumab groups (45.8 months vs 30.0 months, P < 0.0001). Among the 178 (75.1%) patients who received cerebral radiotherapy, the median OS of patients in the bevacizumab + cerebral radiotherapy group was 45.8 months versus 32.0 months in the non-bevacizumab + cerebral radiotherapy group, respectively (P = 0.0007). Patients treated with bevacizumab after cerebral radiotherapy had a longer median OS than patients treated with bevacizumab before cerebral radiotherapy (59.4 months vs 33.7 months, P = 0.0198). In the univariate analysis, smoking status, Lung-molGPA scores, and bevacizumab therapy showed correlations (HR = 1.450, P = 0.045; HR = 0.700, P = 0.023; HR = 0.499, P < 0.001). Multivariate analysis showed that bevacizumab therapy alone (hazard ratio [HR] = 0.514; P < 0.001) was independently associated with improved OS.
In patients with BM from EGFR-mutated NSCLC, cerebral radiotherapy with bevacizumab markedly improved OS. This improvement was more evident after cerebral radiotherapy.
本研究旨在确定贝伐珠单抗联合治疗是否能提高脑转移（BM）表皮生长因子受体（EGFR）突变型非小细胞肺癌（NSCLC）患者接受脑部放疗后的总生存期（OS）。
共纳入符合本回顾性研究标准的 237 例 EGFR 突变肺腺癌伴 BM 患者，其中贝伐珠单抗治疗组 102 例，非贝伐珠单抗组 135 例。采用 Kaplan-Meier 法进行生存分析。采用单因素和多因素分析确定 EGFR 突变型 BM 患者的预后因素。
末次随访结束时，176 例（74.3%）患者死亡，中位总生存期（OS）为 34.2 个月。贝伐珠单抗组和非贝伐珠单抗组中位 OS 有显著差异（45.8 个月比 30.0 个月，P<0.0001）。在 178 例（75.1%）接受脑部放疗的患者中，贝伐珠单抗+脑部放疗组的中位 OS 为 45.8 个月，而非贝伐珠单抗+脑部放疗组为 32.0 个月（P=0.0007）。脑部放疗后接受贝伐珠单抗治疗的患者中位 OS 长于脑部放疗前接受贝伐珠单抗治疗的患者（59.4 个月比 33.7 个月，P=0.0198）。单因素分析显示，吸烟状态、Lung-molGPA 评分和贝伐珠单抗治疗与相关性（HR=1.450，P=0.045；HR=0.700，P=0.023；HR=0.499，P<0.001）。多因素分析显示，贝伐珠单抗单药治疗（风险比[HR]=0.514；P<0.001）与 OS 改善独立相关。
在 EGFR 突变型 NSCLC 伴 BM 患者中，贝伐珠单抗联合脑部放疗显著提高了 OS。在脑部放疗后，这种改善更为明显。
