Bevacizumab Combined with Continuation of EGFR-TKIs in NSCLC Beyond Gradual Progression

OBJECTIVE: Continuation of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) has shown potential in prolonging survival in patients with non-small cell lung cancer (NSCLC) harboring EGFR mutation who had gradual progression at initial targeting therapy. However, it remains unknown whether the combination of bevacizumab and continuation of EGFR-TKIs would benefit this subpopulation. This study retrospectively explored the effect of bevacizumab combined with EGFR-TKIs in NSCLC beyond gradual progression in the real-world setting. METHODS: The records of 48 patients were reviewed who received bevacizumab and continuation of EGFR-TKIs beyond gradual progression at initial targeting therapy. The response to the treatment and post progression survival (PPS) were reviewed and analyzed. RESULTS: The median PPS was 11.4 months (95% CI 7.368–15.492) for all patients included at the median follow-up time of 17.3 months. The objective response rate (ORR) was 8.3%, and the disease control rate (DCR) was 86.1% (with 3 partial response and 28 stable disease) in 36 patients who were evaluable for response with at least one measurable lesion. Univariate Cox analysis showed that age <60, male sex, and EGFR exon19 deletion mutation were associated with longer PPS (P<0.05). Patients harboring EGFR exon19 deletion mutation had significantly longer PPS than those with EGFR exon21 L858R mutation, with an mPPS of 15.5 months and 5.7 months, respectively (HR=0.251, 95% CI 0.112–0.561, P=0.019). Multivariate Cox analysis indicated that age <60 and EGFR exon19 deletion mutation were associated with longer PPS (P<0.05). CONCLUSION: Continuation of EGFR-TKI with the combination of bevacizumab is a reasonable strategy in NSCLC patients beyond gradual progression in previous EGFR-TKI treatment. Younger patients with EGFR exon19 deletion mutation may benefit more from the combination therapy.