SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1496611
PD-1/PD-L1 inhibitors plus Bevacizumab plus chemotherapy versus PD-1/PD-L1 inhibitors plus chemotherapy for advanced non-small cell lung cancer: a phase 3 RCT based meta-analysis
Provisionally accepted
- 1Nanchang University, Nanchang, Jiangxi Province, China
- 2Shangrao People's Hospital, Shangrao, China
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Background: Combining PD-1/PD-L1 inhibitors with chemotherapy (PIC) is a standard first-line treatment for advanced non-small cell lung cancer (NSCLC). The addition of bevacizumab to this regimen (PD-1/PD-L1 inhibitors+bevacizumab+chemotherapy [PIBC]) remains controversial regarding its potential to enhance antitumor efficacy in clinical practice. This meta-analysis aims to compare the antitumor effectiveness and safety profiles of PIBC with PIC.Methods: We systematically searched six databases to identify eligible RCTs. The primary outcomes were overall survival (OS) and progression-free survival (PFS), while the secondary outcomes included treatment responses and adverse events (AEs).Results: Three RCTs (IMpower150, jRCT2080224500, and ORIENT-31) comprising a total of 1529 patients were analyzed. The PIBC regimen significantly improved PFS (hazard ratio [HR]: 0.76 [0.66, 0.87], P < 0.0001), objective response rate (risk ratio [RR]: 1.36 [1.22, 1.51], P < 0.00001), and disease control rate (RR: 1.06 [1.00, 1.12], P = 0.04). The PFS rates were also higher in the PIBC group at 6 and 18 months. Both groups showed similar results in terms of OS, 3-36 month OS rates, and total AEs. However, the PIBC group exhibited a higher incidence of grade 3-5 AEs, serious AEs, grade 3-5 treatment-related AEs (TRAEs) and serious TRAEs. The most frequent grade 3-5 AEs in the PIBC group included anorexia (36.40%), decreased neutrophil count (16.25%), neutropenia (13.50%), reduced white blood cell count (12.12%), and febrile neutropenia (9.42%).Conclusions: PIBC appears to be better than PIC for advanced NSCLC offering improved PFS and response rates (ORR and DCR). However, its higher incidence of AEs requires cautious attention.
Keywords: PD-1/PD-L1 inhibitors, bevacizumab, chemotherapy, Non-small cell lung cancer, Meta-analysis
Received: 14 Sep 2024; Accepted: 29 Apr 2025.
Copyright: © 2025 Song, Qiu, Fan and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yongqing Han, Shangrao People's Hospital, Shangrao, China
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