First-line pemetrexed-platinum doublet chemotherapy with or without bevacizumab in non-squamous non-small cell lung cancer: A real-world propensity score-matched study in China.

Fei Qi,Jie Wang,Xingsheng Hu,Yutao Liu,Mei Dong,Jianchun Duan,Zhijie Wang

doi:10.21147/j.issn.1000-9604.2019.05.05

Abstract

ObjectiveTo evaluate the efficacy and safety profile of first-line bevacizumab (Bev)-containing pemetrexed-platinum chemotherapy in a real-world Chinese cohort with advanced non-squamous non-small cell lung cancer (NS-NSCLC).MethodsA total of 415 eligible patients with NS-NSCLC who received first-line pemetrexed-platinum chemotherapy at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between February 2010 and September 2017 were reviewed retrospectively: 309 Bev(−) and 106 Bev(+) cases. Bev was administered at 7.5 mg/kg every 3 weeks in the Bev(+) group. To reduce the risk of a selection bias, a propensity score-matching (PSM) was conducted and 105 pairs of Bev(−) and Bev(+) cases were identified.ResultsThe median duration of follow-up was 15.8 months. The median progression-free survival (PFS) was prolonged significantly in the Bev(+) group than in the Bev(−) group in overall (9.8vs. 7.8 months, P=0.006) and PSM pairs (9.8 vs. 6.6 months, P<0.001). Moreover, patients receiving maintenance therapy with pemetrexed plus Bev had longer PFS than those interrupted after induction chemotherapy, or those receiving mono-maintenance with pemetrexed (12.3vs. 4.8 vs. 8.6 months; P<0.001). Multivariate analyses revealed Bev to be one of the favorable prognostic factors for PFS, along with the predictor of maintenance therapy. ConclusionsFirst-line induction and maintenance therapy with Bev (7.5 mg/kg every 3 weeks) combined with pemetrexed-platinum chemotherapy was efficacious and superior to non-Bev chemotherapy in Chinese patients with advanced NS-NSCLC.

Highlights

Non-small cell lung cancer (NSCLC) accounts for 80% of all cases of lung cancer worldwide and in China, and most patients are staged as “unresectable”, “advanced” or “metastatic” [1,2]
Since 2004, it has been demonstrated that Bev-combined platinum-based standardized treatment can prolong progression-free survival (PFS) of patients with advanced non-squamous non-small cell lung cancer (NS-NSCLC) who can tolerate such treatment [10,11,12]
Bev-containing regimens were proven to be one of the significant beneficial prognostic factors of PFS before (HR=0.70; 95% confidence interval (95% CI), 0.55−0.90; P=0.005) and after propensity score-matching (PSM) (HR=0.66; 95% CI, 0.48−0.90; P=0.010)

Summary

Introduction

Non-small cell lung cancer (NSCLC) accounts for 80% of all cases of lung cancer worldwide and in China, and most patients are staged as “unresectable”, “advanced” or “metastatic” [1,2]. Platinum-based chemotherapy regimens have, for a long time, been the standard first-line treatment for NSCLC with no sensitizing genetic mutations [3]. Since 2004, it has been demonstrated that Bev-combined platinum-based standardized treatment can prolong progression-free survival (PFS) of patients with advanced non-squamous non-small cell lung cancer (NS-NSCLC) who can tolerate such treatment [10,11,12]. Based on such findings, combination of Bev with chemotherapy was approved by the USA Food and Drug Administration for first-line treatment of NS-NSCLC. Most available supporting data were from studies of paclitaxel/platinum in combination with Bev in Western countries, in which Bev was administered at 15 mg/kg every 3 weeks

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Conclusion