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Journal of Cancer Research and Clinical Oncology

, Volume 145, Issue 10, pp 2555–2564 | Cite as

Correlation between the qualification for bevacizumab use and the survival of patients with non-small cell lung cancer harboring the epidermal growth factor receptor mutation: a retrospective analysis

  • Taiki Hakozaki
  • Yusuke OkumaEmail author
  • Kana Hashimoto
  • Yukio Hosomi
Original Article – Clinical Oncology
  • 270 Downloads

Abstract

Purpose

Previously, the combination of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) and bevacizumab (BEV) was investigated. A subgroup analysis of the IMpower150 trial, which investigated the combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab (ABCP), demonstrated the benefit of ABCP in patients harboring EGFR mutations. This study aims to assess the prognostic significance of the qualification for BEV use and the proportion of patients who potentially benefit from BEV-containing combination therapy before and after initial EGFR-TKI treatment.

Methods

We retrospectively analyzed the data of 297 patients with advanced or recurrent non-squamous non-small cell lung cancer (NSCLC) harboring EGFR mutations who had received EGFR-TKIs. We performed statistical analyses using the Kaplan–Meier method and the Cox regression adjusted for risk factors.

Results

Of the 297 patients, 203 (68%) were eligible to receive BEV (“BEV fit”) at the time of EGFR-TKI initiation. Among the “BEV unfit” patients at baseline (n = 70), 14 (20%) became eligible to receive ABCP (“ABCP fit”) at the time of EGFR-TKI failure. The median overall survival (OS) of the “BEV fit” and “BEV unfit” patients was 26.2 [95% confidence interval (CI) 23.7–31.2] and 19.1 (95% CI 15.0–25.1) months, respectively (P < 0.001). The multivariate analysis revealed a marked correlation between survival and the qualification for BEV use.

Conclusions

The qualification for BEV use at baseline is independently related to the OS. Some patients harboring EGFR mutations, including those who were “BEV unfit” at baseline, could be eligible for the ABCP regimen after EGFR-TKI treatment.

Keywords

Non-small cell lung cancer Epidermal growth factor Tyrosine kinase inhibitor Bevacizumab Prognosis 

Abbreviations

NSCLC

Non-small cell lung cancer

EGFR

Epidermal growth factor receptor

TKI

Tyrosine kinase inhibitor

BEV

Bevacizumab

VEGF

Vascular endothelial growth factor

ASCO

American Society of Clinical Oncology

EB

Erlotinib and bevacizumab

PFS

Progression-free survival

HR

Hazard ratio

CI

Confidence interval

ICI

Immune checkpoint inhibitor

ABCP

Atezolizumab plus carboplatin, paclitaxel, and bevacizumab

ALK

Anaplastic lymphoma kinase

non-SQ

Non-squamous

CT

Computed tomography

ECOG-PS

Eastern Cooperative Oncology Group-Performance Status

OS

Overall survival

NOS

Not other specified

PD

Progressive disease

CEA

Carcinoembryonic antigen

IQR

Interquartile range

RAM

Ramucirumab

Notes

Acknowledgements

We thank Enago (https://www.enago.jp/) for the English language review.

Author contributions

TH, YO, and KH acquired the clinical data. TH and YO drafted the manuscript. TH, YO, KH, and YH interpreted the data.

Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None.

Ethical approval

This study protocol was approved by the Ethics Committee of the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital and was conducted in accordance with the tenets of the Declaration of Helsinki.

Supplementary material

432_2019_2985_MOESM1_ESM.docx (27 kb)
Supplementary material 1 (DOCX 26 kb)
432_2019_2985_MOESM2_ESM.tif (233 kb)
Supplementary material 2 (TIFF 233 kb)
432_2019_2985_MOESM3_ESM.docx (35 kb)
Supplementary material 3 (DOCX 34 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Thoracic Oncology and Respiratory MedicineTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  2. 2.Department of Thoracic OncologyNational Cancer Center HospitalTokyoJapan

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