PD-(L)1 inhibitors plus bevacizumab and chemotherapy as first-line therapy in PD-L1 negative metastatic lung adenocarcinoma: A real-world data.

person Yihui Ge Phase I Clinical Research Center, Shandong University Cancer Center, Jinan, Shandong, China info_outline Yihui Ge, Yuping Sun, Aiqin Gao, Juan Li, Dahai Wang, Jiake Wu, Yanxin Sun, Haifeng Sun, Haodong Sun, Jie Li

Authors person Yihui Ge Phase I Clinical Research Center, Shandong University Cancer Center, Jinan, Shandong, China info_outline Yihui Ge, Yuping Sun, Aiqin Gao, Juan Li, Dahai Wang, Jiake Wu, Yanxin Sun, Haifeng Sun, Haodong Sun, Jie Li Organizations Phase I Clinical Research Center, Shandong University Cancer Center, Jinan, Shandong, China, Shandong Cancer Hospital, Jinan, China, Department of Thoracic Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China, Phase I Clinical Research Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, Shandong Cancer Hospital and Institute Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China, Shandong First Medical University, Jinan, Shandong, China, Shandong Second Medical University, Weifang, Shandong, China, Shandong University Cancer Center, Jinan, China, Shandong Cancer Hospital and Institute, Jinan, China Abstract Disclosures Research Funding No funding sources reported Background: Chemotherapies combined with immune checkpoint inhibitors (ICIs) and/or bevacizumab (named IC, BC and IBC respectively) are the preferred first-line options for PD-L1 negative and oncogenic driver wild-type metastatic lung adenocarcinoma. However, the optimal strategy is still undetermined. Methods: This retrospective real-world study enrolled PD-L1 negative metastatic lung adenocarcinoma patients from four cancer centers between January 1, 2018 and June 30, 2022. All the patients received IC, BC, or IBC as the first-line therapies. The efficacy and safety were evaluated. Results: A total of 205 patients were included, with 60, 83, and 62 patients in IC, BC, and IBC groups, respectively. Patients receiving IBC obtained the highest objective response rate (ORR) (43.5%) and disease control rate (DCR) (100%) relative to those receiving IC (40.4%, 84.2%) or BC (40.5%, 96.2%). Compared with the IC (6.74m) or BC (8.28m) group, IBC group improved significantly median progression-free survival (mPFS) (9.53m, P = 0.005 ). However, the difference in overall survival (OS) were not observed among the three groups. When analyzed based on different clinical and molecular information, we found that male gender, ever smoking, wild-type genes, and adrenal metastasis predicts superior PFS benefit when treated with IBC. In patients with liver metastasis, IBC or BC treatment achieved better PFS compared with IC. No additional adverse reactions were observed in IBC group compared with other two groups. Conclusions: Combined IBC treatment achieved superior DCR and PFS compared with IC or BC treatment in patients with PD-L1 negative metastatic lung adenocarcinoma, while did not increase the adverse events.