Bevacizumab plus chemotherapy for patients with advanced pulmonary adenocarcinoma harboring EGFR mutations


                <p>Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) and bevacizumab plus chemotherapy were effective for <em>EGFR</em>-mutant patients. However, the appropriated treatment orders remained controvertible. We investigated the efficacy of treatment orders between bevacizumab plus chemotherapy and EGFR-TKIs for <em>EGFR</em>-mutant patients with advanced pulmonary adenocarcinoma.</p> 

                </span><h3>Patients and methods</h3> 
                <p>This study involved 40 <em>EGFR</em>-mutant patients with advanced pulmonary adenocarcinoma who were treated with bevacizumab plus carboplatin and paclitaxel (Bev + CP) and EGFR-TKIs in different treatment orders or gemcitabine plus cisplatin (GP) in first-line setting. Seventeen patients were treated with Bev + CP and 10 cases with GP in first-line treatment. Thirteen patients received EGFR-TKIs after first-line Bev + CP regimen, while 13 patients were treated with first-line EGFR-TKIs. Progression-free survival (PFS), the response rate (ORR) and overall survival (OS) were evaluated.</p> 

                <p>Median PFS of Bev + CP treatment was significantly longer in first-line than non-first-line settings (11.7 vs. 5.6 months, <em>P</em> = 0.003). Median OS was 37.8 months for <em>EGFR</em>-mutant patients with first-line Bev + CP followed by second-line EGFR-TKIs and 31.0 months for those with first-line EGFR-TKIs and non-first-line Bev + CP, respectively (<em>P</em> = 0.509). Median PFS was 11.7 (95% CI 10.6–12.8) months for Bev + CP group and 4.7 (95% CI 4.4–5.0) months for GP group with the hazard ratio of 0.17 (<em>P</em> = 0.001). ORR was 70.6 and 50.0% in the two groups, respectively (<em>P</em> = 0.415). However, there was no significant difference in median OS (33.7 vs 27.8 months, <em>P</em> = 0.293).</p> 

                <p>First-line Bev + CP followed by EGFR-TKIs might possibly provide favorable prognosis for <em>EGFR</em>-mutant patients. Bev + CP regimen significantly prolonged PFS in first-line than non-first-line settings. These findings warrant further investigations.</p> 
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