Addition of Bevacizumab to Gefitinib Plus Chemotherapy as First-line therapy in EGFR L858R mutate Advanced Non-Small Cell Lung Cancer Patients

Jixian Li¹Xiang Zhan¹Lingli Lei¹Yi Ding¹Jiaxin Li¹Fengge Zhou²Alei Feng²Zhe Yang^1*

• ¹Shandong Provincial Hospital, Shandong University, jinan, China
• ²Shandong Provincial Hospital, Jinan, China

Background: For advanced non-small cell lung cancer (NSCLC) patients with the epidermal growth factor receptor (EGFR) L858R mutation, the efficacy of the combination of tyrosine kinase inhibitor (TKI) and chemotherapy is suboptimal. Currently, it is unclear whether the combination of bevacizumab, gefitinib, and chemotherapy could improve the survival. Materials and methods: Data was retrospectively collected at Shandong Provincial Hospital between June 2019 and December 2022. The patients were divided into two groups, ATC group receiving bevacizumab, gefitinib, and chemotherapy, and TC group receiving gefitinib and chemotherapy. After propensity score matching (PSM), progression-free survival (PFS) and overall survival (OS) were calculated along with the objective response rate (ORR) and disease control rate (DCR). Results: The study enrolled 217 patients, 58 in the ATC group and 149 in the TC group, and was adjusted to 55 and 118 after PSM, respectively. Both the ORR and DCR were higher in the ATC group compared to the TC group (ORR: 76.4% versus 65.3%; DCR: 89.1% versus 80.1%). After 41.30 months of follow-up, the first-line PFS in the ATC group was significantly longer than in the TC group, while OS was not (PFS: 22.26 months versus 19.18 months, P = 0.02; OS: 42.18 months versus 39.42 months, P = 0.91). Univariate and multivariate analyses indicated that ATC treatment and the absence of brain metastases positively predict PFS, with no variables that dependently predict OS. Conclusion: The combination of bevacizumab, gefitinib, and chemotherapy significantly benefits patients with the L858R mutation in first-line PFS but not OS.