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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

邮发代号 80-967

2019 Impact Factor: 3.421

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Frontiers of Medicine  2022, Vol. 16 Issue (4): 610-617   https://doi.org/10.1007/s11684-021-0827-8
  本期目录
Bevacizumab in combination with pemetrexed and platinum for elderly patients with advanced non-squamous non-small-cell lung cancer: a retrospective analysis
Yaru Tian1, Hairong Tian1,2, Xiaoyang Zhai1, Hui Zhu1(), Jinming Yu1()
1. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan 250117, China
2. Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan 250117, China
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Abstract：

Bevacizumab, an anti-VEGF monoclonal antibody, has significantly improved the clinical outcomes of patients with advanced non-squamous NSCLC (ns-NSCLC). However, the safety and efficacy of bevacizumab for elderly patients with advanced NSCLC require further investigation. Thus, 59 patients were included in the present retrospective study, 22 patients in the bevacizumab plus pemetrexed and platinum (B+PP) group, and 37 patients in the pemetrexed and platinum (PP) group. For the entire cohort of patients, the median OS was 33.3 months, and the 1-year and 2-year overall survival rates were 88.5% and 67.8%, respectively. The median OS and 1-year and 2-year OS rates were 20.5 months, 70.3% and 0%, respectively, in the B+PP group and 33.4 months, 97.0% and 89.4%, respectively, in the PP group (P <0.001). The incidence of grade≥3 adverse events was higher in the B+PP group than in the PP group (27.3% vs. 10.8%, respectively; P=0.204). Univariate and multivariate analyses suggested that the receipt of≥5 cycles of first-line chemotherapy was an independent favorable prognostic factor for OS, whereas the addition of bevacizumab was an unfavorable prognostic factor. With increased toxicities, the addition of bevacizumab to PP does not improve the overall survival of elderly patients with advanced ns-NSCLC.
Key words： bevacizumab    elderly patient    advanced non-small-cell lung cancer    overall survival    toxicity
收稿日期: 2020-03-20      出版日期: 2022-09-02
Corresponding Author(s): Hui Zhu,Jinming Yu   
 引用本文:   
. [J]. Frontiers of Medicine, 2022, 16(4): 610-617.
Yaru Tian, Hairong Tian, Xiaoyang Zhai, Hui Zhu, Jinming Yu. Bevacizumab in combination with pemetrexed and platinum for elderly patients with advanced non-squamous non-small-cell lung cancer: a retrospective analysis. Front. Med., 2022, 16(4): 610-617.
 链接本文:  
https://academic.hep.com.cn/fmd/CN/10.1007/s11684-021-0827-8
https://academic.hep.com.cn/fmd/CN/Y2022/V16/I4/610
Characteristic 　 Number of patients (%) ?P
Total B+ PP (n = 22) PP (n = 37)
Age, year 　 　 　 　
?Median 69 69 69 　
?Range 65–85 65–76 65–85 　
??≥ 69 34 13 (59.1) 21 (56.8) ?0.861
??< 69 25 9 (40.9) 16 (43.2)
Sex 　 　 　 　
?Male 41 13 (59.1) 28 (75.7) ?0.181
?Female 18 9 (40.9) 9 (24.3)
KPS score 　 　 　 　
?≥ 80 56 20 (90.9) 36 (97.3) ?0.640
?< 80 3 2 (9.1) 1 (2.7)
Smoking status 　 　 　 　
?Never smoker 24 10 (45.5) 14 (37.8) ?0.565
?Ever smoker 35 12 (54.5) 23 (62.2)
Histology 　 　 　 　
?Adenocarcinoma 58 21 (95.5) 37 (100) ?0.373
?Others 1 1 (4.5) 0 (0)
Stage 　 　 　 　
?IIIB 11 6 (27.3) 5 (13.5) ?0.334
?IV 48 16 (72.7) 32 (86.5)
Hypertension 　 　 　 　
?Yes 16 5 (22.7) 11 (29.7) ?0.559
?No 43 17 (77.3) 26 (70.3)
EGFR mutation status assessmenta 42 16 26 　
?EGFR mutation positive 16 5 (31.3) 11 (42.3) ?0.474
?EGFR wild type 26 11 (68.8) 15 (57.7)
Tab.1  
Treatment 　 Number of patients (%) ??P
Total B+ PP (n = 22) PP (n = 37)
Number of first-line chemotherapy cycles 　 　 　
?Median 5 4 6 　
?Range 2–9 2–9 2–9 　
??≥ 5 32 9 (40.9) 23 (62.2) ??0.113
??< 5 27 13 (59.1) 14 (37.8)
Maintenance 　 　 　 　
?Yes 31 7 (31.8) 24 (64.9) ??0.014
?No 28 15 (68.2) 13 (35.1)
Maintenance regimens 31 7 24 　
?Bevacizumab+ pemetrexed 7 6 1 　
?Pemetrexed
?TKIs		 22
2		 1
0		 21
2		 　
Thoracic radiation 　 　 　 　
?Yes 16 6 (27.3) 10 (27.0) ??0.984
?No 43 16 (62.3) 27 (73.0)
Second-line treatment 　 　 　 　
?Yes 28 8 (72.7) 20 (83.3) ??0.785
?No 7 3 (27.3) 4 (16.7)
Second-line regimens
?Chemotherapy
?TKIs		 19
9		 5 (62.5)
3 (37.5)		 14 (70.0)
6 (30.0)		 ??1.000
Tab.2  
Fig.1  
Fig.2  
Fig.3  
Characteristic mOS, month 1-Year OS, % 2-Year OS, % Chi-square statistic P
Age, year 　 　 　 　 　
?≥ 69 25.4 86.6 60.5 3.13 0.077
?< 69 NR 91.0 75.9
Sex 　 　 　 　 　
?Male 33.3 89.6 70.1 0.32 0.569
?Female NR 83.7 62.7
KPS score 　 　 　 　 　
?≥ 80 33.4 89.7 74.2 4.98 0.026
?< 80 22.6 66.7 0.0
Smoking status 　 　 　 　 　
?Never smoker NR 89.3 71.4 1.58 0.209
?Ever smoker 33.3 87.6 65.3
Stage 　 　 　 　 　
?IIIB 25.4 64.3 64.3 1.40 0.237
?IV 33.4 91.2 66.9
EGFR mutation status assessment 　 　 　
?EGFR mutation positive 37.2 79.1 69.2 0.37 0.542
?EGFR wild type 33.4 95.2 71.1
Number of first-line chemotherapy cycles 　 　 　
?≥ 5 37.2 100.0 95.0 12.52 <0.001
?< 5 22.6 74.6 42.6
Maintenance 　 　 　 　 　
?Yes NR 93.1 74.8 2.64 0.104
?No 33.3 82.6 55.1
Thoracic radiation 　 　 　 　
?Yes NR 93.3 62.2 0.35 0.555
?No 33.3 87.1 67.8
Bevacizumab 　 　 　 　 　
?Yes 20.5 70.3 0.0 14.68 <0.001
?No 33.4 97.0 81.9
Tab.3  
Characteristic HR 95% CI Chi-square statistic P
Age, year (≥ 69 vs. < 69) 2.023 0.513–7.977 1.013 0.314
Sex (male vs. female) 0.891 0.131–6.043 0.014 0.906
Number of first-line chemotherapy cycles (≥ 5 vs. < 5) 0.045 0.005–0.426 7.288 0.007
Maintenance (yes vs. no) 0.864 0.218–3.419 0.043 0.835
Thoracic radiation (yes vs. no) 0.176 0.015–2.117 1.875 0.171
Bevacizumab (yes vs. no) 13.733 1.855–101.675 6.579 0.010
Tab.4  
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