Efficacy of PD-1 inhibitor plus chemotherapy and bevacizumab in initial therapy of metastatic non-squamous non-small cell lung cancer with driver gene negativity: A real-world retrospective study

Immune checkpoint inhibitors (ICIs) in conjunction with chemotherapy (IC), bevacizumab in conjunction with chemotherapy (AC), and ICI in conjunction with chemotherapy and bevacizumab (IAC) are all used as initial therapies for metastatic lung adenocarcinoma with driver gene negativity. Few studies have investigated which treatment regimen is more efficacious in the Chinese population. Data from metastatic lung adenocarcinoma patients with driver gene negativity at the Affiliated Hospital of Qingdao University were retrospectively collected. The propensity score matching approach was used to pair the patients. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves. Independent factors affecting PFS and OS were determined using the Cox proportional hazards model. A total of 119 patients were enrolled in this study. After propensity score matching, the PFS of patients treated with IAC was substantially lengthier than that of patients treated with AC (median PFS, 15.8 vs 8.5 months; P = .0057). The IAC group owned lengthier PFS than the IC group, nonetheless the difference was not regarded as statistically significant. The PFS in the IC group did not differ substantially from that in the AC group. IAC had a longer OS than AC (median OS [mOS]: 35.9 vs 26.9 months; P = .021). The OS of IAC was numerically prolonged compared with that of IC, but not statistically different. Statistical differences were not observed between the OS of the IC and AC groups. The COX analysis showed that therapy and efficacy to complete response/partial response independently influenced on PFS and OS, and age independently influenced on PFS. No differences in adverse events were observed among the 3 groups. IAC may be the best initial therapy option for patients with metastatic lung adenocarcinoma with driver gene negativity.