First-line treatment of driver gene-negative metastatic lung adenocarcinoma with malignant pleural effusion: Should chemotherapy be combined with an immune checkpoint inhibitor or bevacizumab?

SummaryPatients with metastatic lung adenocarcinoma (MLA) and malignant pleural effusion (MPE) without driver gene mutations have a poor prognosis. None of the standard treatment strategies is recommended for such patients. We retrospectively analyzed the efficacy of the first-line treatment for this specific population: standard platinum-based doublet chemotherapy (CT), CT plus an immune checkpoint inhibitor (CT plus ICI), and CT plus bevacizumab (CT plus Bev). A total of 323 eligible patients were enrolled: CT alone (n = 166), CT plus Bev (n = 72), and CT plus ICI (n = 85). Treatment efficacy assessments were performed every two cycles according to the RECIST guidelines. The endpoints were overall survival (OS) and progression-free survival (PFS). Kaplan-Meier (K‒M) curves and the log-rank test were used to compare OS and PFS.p <  0.05 was the threshold of significance (statistical software: SPSS). The median follow-up was 11.4 months (range, 2.1–49.6 months). PFS and OS in the CT plus ICI/CT plus Bev cohort were significantly longer than those in the CT group (PFS: 7.8/6.4/3.9 months,p <  0.0001; OS: 16.4/15.6/9.6 months,p <  0.0001, respectively). CT plus Bev had better PFS and OS than CT plus ICI/CT in PD-L1 <  1% patients (PFS: 8.4/5.0/3.8 months,p <  0.0001; OS: 15.6/12.9/9.3 months,p <  0.0001). Among patients with PD-L1 1–49%, CT plus ICI led to a longer PFS and OS (PFS: 8.9/5.8/4.2 months,p = 0.0...
Source: Investigational New Drugs - Category: Drugs & Pharmacology Source Type: research