Immunotherapy combined with chemotherapy improved clinical outcomes over bevacizumab combined with chemotherapy as first‐line therapy in adenocarcinoma patients

PURPOSE: No definite conclusion has yet to be reached for the first‐line treatment combined with chemotherapy for advanced adenocarcinoma NSCLC patients with negative driver genes. This study sought to compare the clinical outcomes of Beva+ChT and IO+ChT as first‐line treatment for this population and investigated whether the statuses of BM, PD‐L1 expression, and KRAS and TP53 mutations could influence the results. PATIENTS AND METHODS: The clinical data of patients with adenocarcinoma NSCLC who received first‐line therapy were retrospectively collected and the patients were assigned to the IO+ChT and Beva+ChT groups. The disease control rate (DCR), progression‐free survival (PFS), and overall survival (OS) were evaluated between the two groups. The survival effects of BM, PD‐L1 expression, and KRAS and TP53 mutations were also evaluated. RESULTS: From April 2018 to October 2020, a total of 105 patients with first‐line therapy were included in our analysis; 54 (51.4%) patients were included in the IO+ChT group and 51 (48.6%) patients were included in the Beva+ChT group. The results showed that OS (NR vs. 18.3 m, p = 0.011) and PFS (14.9 m vs. 6.3 m, p < 0.001) were superior in patients in the IO+ChT group than in patients in the Beva+ChT group. Further analysis revealed that the OS (median OS: NR vs. 14.7 months, p = 0.039) and PFS (median PFS: 18.5 vs. 5.5 months, p < 0.001) advantages of the IO+ChT group were also seen in the PD‐L1 > 1% subgroup but were not seen in the PD‐L1 < 1%, BM or KRAS mutation subgroups. CONCLUSIONS: ICIs combined with ChT improved clinical outcomes over Beva combined with ChT as first‐line therapy for adenocarcinoma patients without driver gene alterations, especially in patients with PD‐L1 ≥ 1%.