Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer

Yu Chen Huang, Shih Min Shen, Chien Ying Liu, Stelios Pavlidis, Chih Liang Wang, How Wen Ko, Fu Tsai Chung, Tin Yu Lin, Po Hao Feng, Kang Yun Lee, Yi Ke Guo, Cheng Ta Yang, Chih Hsi Scott Kuo

Research output: Contribution to journalArticle

Abstract

Background: VEGF plays a key role in tumor angiogenesis and immunosuppression. VEGF-blocking has proven beneficial for EGFR mutant and wild-type nonsquamous non-small cell lung cancer (nonsq-NSCLC); however, the number of cycles and treatment line yielding the optimal benefit are unknown. Methods: We retrospectively analyzed the data of 115 patients with advanced/metastatic nonsq-NSCLC administered at least one cycle of bevacizumab. The number of bevacizumab cycles was treated as a time-dependent covariate. Predictors of overall survival (OS) were investigated. Results: Bevacizumab was used as first-line treatment in 47 (40.9%) patients, with a median of five cycles (range: 1–31). Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.68–8.51; P < 0.001), wild-type EGFR (HR 2.61, 95% CI 1.45–4.70; P = 0.001), and bleeding during bevacizumab treatment (HR 3.63, 95% CI 1.77–7.45; P < 0.001) were predictive of poor OS; the number of bevacizumab cycles and first-line administration were not. In the wild-type EGFR subgroup, the number of bevacizumab cycles (≥ 5 vs. 1–4) was associated with a significant OS benefit (HR 0.28, 95% CI 0.08–0.98; P = 0.044); first-line administration also showed an OS benefit (HR 0.48, 95% CI 0.20–1.17; P = 0.105). A significant association between the number of cycles and EGFR status was identified (P = 0.046). Conclusion: OS benefit is negatively affected by bleeding events in bevacizumab-treated patients. Prolonged and early introduction of bevacizumab may provide an OS benefit for patients with wild-type EGFR nonsq-NSCLC.

Original languageEnglish
JournalThoracic Cancer
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Non-Small Cell Lung Carcinoma
Survival
Confidence Intervals
Therapeutics
Vascular Endothelial Growth Factor A
Hemorrhage
Bevacizumab
Immunosuppression
Neoplasms

Keywords

  • Bevacizumab
  • EGFR
  • NSCLC
  • VEGF

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer. / Huang, Yu Chen; Shen, Shih Min; Liu, Chien Ying; Pavlidis, Stelios; Wang, Chih Liang; Ko, How Wen; Chung, Fu Tsai; Lin, Tin Yu; Feng, Po Hao; Lee, Kang Yun; Guo, Yi Ke; Yang, Cheng Ta; Kuo, Chih Hsi Scott.

In: Thoracic Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Huang, Yu Chen ; Shen, Shih Min ; Liu, Chien Ying ; Pavlidis, Stelios ; Wang, Chih Liang ; Ko, How Wen ; Chung, Fu Tsai ; Lin, Tin Yu ; Feng, Po Hao ; Lee, Kang Yun ; Guo, Yi Ke ; Yang, Cheng Ta ; Kuo, Chih Hsi Scott. / Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer. In: Thoracic Cancer. 2018.
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abstract = "Background: VEGF plays a key role in tumor angiogenesis and immunosuppression. VEGF-blocking has proven beneficial for EGFR mutant and wild-type nonsquamous non-small cell lung cancer (nonsq-NSCLC); however, the number of cycles and treatment line yielding the optimal benefit are unknown. Methods: We retrospectively analyzed the data of 115 patients with advanced/metastatic nonsq-NSCLC administered at least one cycle of bevacizumab. The number of bevacizumab cycles was treated as a time-dependent covariate. Predictors of overall survival (OS) were investigated. Results: Bevacizumab was used as first-line treatment in 47 (40.9{\%}) patients, with a median of five cycles (range: 1–31). Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR] 4.78, 95{\%} confidence interval [CI] 2.68–8.51; P < 0.001), wild-type EGFR (HR 2.61, 95{\%} CI 1.45–4.70; P = 0.001), and bleeding during bevacizumab treatment (HR 3.63, 95{\%} CI 1.77–7.45; P < 0.001) were predictive of poor OS; the number of bevacizumab cycles and first-line administration were not. In the wild-type EGFR subgroup, the number of bevacizumab cycles (≥ 5 vs. 1–4) was associated with a significant OS benefit (HR 0.28, 95{\%} CI 0.08–0.98; P = 0.044); first-line administration also showed an OS benefit (HR 0.48, 95{\%} CI 0.20–1.17; P = 0.105). A significant association between the number of cycles and EGFR status was identified (P = 0.046). Conclusion: OS benefit is negatively affected by bleeding events in bevacizumab-treated patients. Prolonged and early introduction of bevacizumab may provide an OS benefit for patients with wild-type EGFR nonsq-NSCLC.",
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T1 - Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer

AU - Huang, Yu Chen

AU - Shen, Shih Min

AU - Liu, Chien Ying

AU - Pavlidis, Stelios

AU - Wang, Chih Liang

AU - Ko, How Wen

AU - Chung, Fu Tsai

AU - Lin, Tin Yu

AU - Feng, Po Hao

AU - Lee, Kang Yun

AU - Guo, Yi Ke

AU - Yang, Cheng Ta

AU - Kuo, Chih Hsi Scott

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: VEGF plays a key role in tumor angiogenesis and immunosuppression. VEGF-blocking has proven beneficial for EGFR mutant and wild-type nonsquamous non-small cell lung cancer (nonsq-NSCLC); however, the number of cycles and treatment line yielding the optimal benefit are unknown. Methods: We retrospectively analyzed the data of 115 patients with advanced/metastatic nonsq-NSCLC administered at least one cycle of bevacizumab. The number of bevacizumab cycles was treated as a time-dependent covariate. Predictors of overall survival (OS) were investigated. Results: Bevacizumab was used as first-line treatment in 47 (40.9%) patients, with a median of five cycles (range: 1–31). Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.68–8.51; P < 0.001), wild-type EGFR (HR 2.61, 95% CI 1.45–4.70; P = 0.001), and bleeding during bevacizumab treatment (HR 3.63, 95% CI 1.77–7.45; P < 0.001) were predictive of poor OS; the number of bevacizumab cycles and first-line administration were not. In the wild-type EGFR subgroup, the number of bevacizumab cycles (≥ 5 vs. 1–4) was associated with a significant OS benefit (HR 0.28, 95% CI 0.08–0.98; P = 0.044); first-line administration also showed an OS benefit (HR 0.48, 95% CI 0.20–1.17; P = 0.105). A significant association between the number of cycles and EGFR status was identified (P = 0.046). Conclusion: OS benefit is negatively affected by bleeding events in bevacizumab-treated patients. Prolonged and early introduction of bevacizumab may provide an OS benefit for patients with wild-type EGFR nonsq-NSCLC.

AB - Background: VEGF plays a key role in tumor angiogenesis and immunosuppression. VEGF-blocking has proven beneficial for EGFR mutant and wild-type nonsquamous non-small cell lung cancer (nonsq-NSCLC); however, the number of cycles and treatment line yielding the optimal benefit are unknown. Methods: We retrospectively analyzed the data of 115 patients with advanced/metastatic nonsq-NSCLC administered at least one cycle of bevacizumab. The number of bevacizumab cycles was treated as a time-dependent covariate. Predictors of overall survival (OS) were investigated. Results: Bevacizumab was used as first-line treatment in 47 (40.9%) patients, with a median of five cycles (range: 1–31). Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.68–8.51; P < 0.001), wild-type EGFR (HR 2.61, 95% CI 1.45–4.70; P = 0.001), and bleeding during bevacizumab treatment (HR 3.63, 95% CI 1.77–7.45; P < 0.001) were predictive of poor OS; the number of bevacizumab cycles and first-line administration were not. In the wild-type EGFR subgroup, the number of bevacizumab cycles (≥ 5 vs. 1–4) was associated with a significant OS benefit (HR 0.28, 95% CI 0.08–0.98; P = 0.044); first-line administration also showed an OS benefit (HR 0.48, 95% CI 0.20–1.17; P = 0.105). A significant association between the number of cycles and EGFR status was identified (P = 0.046). Conclusion: OS benefit is negatively affected by bleeding events in bevacizumab-treated patients. Prolonged and early introduction of bevacizumab may provide an OS benefit for patients with wild-type EGFR nonsq-NSCLC.

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KW - EGFR

KW - NSCLC

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