Abstract
PurposeEpidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and bevacizumab plus chemotherapy were effective for EGFR-mutant patients. However, the appropriated treatment orders remained controvertible. We investigated the efficacy of treatment orders between bevacizumab plus chemotherapy and EGFR-TKIs for EGFR-mutant patients with advanced pulmonary adenocarcinoma.Patients and methodsThis study involved 40 EGFR-mutant patients with advanced pulmonary adenocarcinoma who were treated with bevacizumab plus carboplatin and paclitaxel (Bev + CP) and EGFR-TKIs in different treatment orders or gemcitabine plus cisplatin (GP) in first-line setting. Seventeen patients were treated with Bev + CP and 10 cases with GP in first-line treatment. Thirteen patients received EGFR-TKIs after first-line Bev + CP regimen, while 13 patients were treated with first-line EGFR-TKIs. Progression-free survival (PFS), the response rate (ORR) and overall survival (OS) were evaluated.ResultsMedian PFS of Bev + CP treatment was significantly longer in first-line than non-first-line settings (11.7 vs. 5.6 months, P = 0.003). Median OS was 37.8 months for EGFR-mutant patients with first-line Bev + CP followed by second-line EGFR-TKIs and 31.0 months for those with first-line EGFR-TKIs and non-first-line Bev + CP, respectively (P = 0.509). Median PFS was 11.7 (95% CI 10.6–12.8) months for Bev + CP group and 4.7 (95% CI 4.4–5.0) months for GP group with the hazard ratio of 0.17 (P = 0.001). ORR was 70.6 and 50.0% in the two groups, respectively (P = 0.415). However, there was no significant difference in median OS (33.7 vs 27.8 months, P = 0.293).ConclusionsFirst-line Bev + CP followed by EGFR-TKIs might possibly provide favorable prognosis for EGFR-mutant patients. Bev + CP regimen significantly prolonged PFS in first-line than non-first-line settings. These findings warrant further investigations.
Highlights
Lung cancer is a leading cause of death both worldwide and in China [1]
Grade 3–4 adverse events included neutropenia (4/17, 23.5%); proteinuria (1/17, 5.9%) and anemia (1/17, 5.9%) in first-line Bev ? CP treatment; leukopenia (1/10, 10.0%); neutropenia (1/10, 10.0%); Our analysis showed that the addition of bevacizumab to CP provided a meaningful benefit in terms of Progression-free survival (PFS) in Epidermal growth factor receptor (EGFR)-mutant patients
Our study indicated that a prolonged PFS of Bev ? CP regimen was obtained in first-line setting than second- or further-line one in EGFR-mutant patients
Summary
More than 70% of patients present with advanced non-small-cell lung cancer (NSCLC) at the time of diagnosis with poor prognosis. The discovery of driver genes has changed treatment for patients with NSCLC and. Chemotherapy is usually used as the subsequent treatment after EGFR TKI failure, resulting the median PFS of only about 4 months [9, 10]. It was reported that frontline EGFR-TKIs can reduced the sensitivity of subsequent platinum-based doublet chemotherapy [9]. EGFR-mutant patients accounted for approximately 30% of NSCLC patients in East Asia, which is more than those of 10% in non-Asia [12, 13].
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