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

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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.

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

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Keywords

  • Bevacizumab
  • EGFR
  • NSCLC
  • VEGF

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Huang, Y. C., Shen, S. M., Liu, C. Y., Pavlidis, S., Wang, C. L., Ko, H. W., Chung, F. T., Lin, T. Y., Feng, P. H., Lee, K. Y., Guo, Y. K., Yang, C. T., & Kuo, C. H. S. (Accepted/In press). Impact of prolonged and early bevacizumab treatment on the overall survival of EGFR-mutant and EGFR-wild type nonsquamous non-small cell lung cancer. Thoracic Cancer. https://doi.org/10.1111/1759-7714.12875