Immunotherapy or antiangiogenic therapy plus chemotherapy as first‐line treatment of patients with PD‐L1(‐) advanced non‐squamous non‐small cell lung cancer in a Chinese cohort

PURPOSE: For patients with advanced nonsquamous non‐small cell lung cancer (NSCLC), immunotherapy or antiangiogenic therapy combined with pemetrexed and cisplatin/carboplatin have both shown significant efficacy at programmed cell death ligand 1 (PD‐L1) levels of <1%. Our study aimed to compare two first‐line regimens for patients with advanced nonsquamous NSCLC who were negative for PD‐L1. METHODS: A retrospective cohort study was conducted comparing the outcomes of patients with advanced PD‐L1(‐) nonsquamous NSCLC who were treated with antiangiogenic therapy plus chemotherapy (A Group) to those who were treated with anti‐PD‐L1 monoclonal antibodies plus chemotherapy (mAbs) (B Group). Both regimens were evaluated for progression‐free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and side effects. RESULTS: 114 patients were enrolled in the study, 82 in Group A and 32 in Group B. Those in Group A had a longer median PFS (9.8 vs. 6.7 months, p = 0.025). The OS was also achieved (p = 0.058). No statistically significant difference was seen in ORR (52.4% vs. 50.0%, p = 0.815) or DCR (93.9% vs. 87.5%, p = 0.225) between the two groups. Patients in the A group who did not smoke and did not have specific metastases could benefit from survival. Adverse events (AEs) in both groups were tolerated. CONCLUSION: Bevacizumab plus chemotherapy outperformed immunotherapy plus chemotherapy in terms of PFS.