Targeted combination of Bevacizumab demonstrates superior efficacy for stage IV Adenocarcinoma of the lung with EGFR mutation: A Real World Study

Background: Research on bevacizumab combined with EGFR-TKIs is limited to erlotinib, and the NCCN guidelines only recommend erlotinib combined with bevacizumab as a nonfirst-line option. Consequently, To address the real-world efficacy of various treatment regimens, we conducted this study. Methods A total of 11,893 patients were screened. The patients were divided into three distinct groups: single targeted group(T), targeted combined chemotherapy group(TC) and targeted combined bevacizumab group(TB), and. The targeted therapy plans encompassed the utilization of first-, second-, and third-generation targeted drugs, namely, Iresa, Ireko, Echtenib, Afatinib, and Osimertinib. The chemotherapy regimen consisted of pemetrexed in combination with platinum, administered in a 21-day cycle for a total of 4–6 cycles. Subsequently, the patients continued receiving targeted drugs until disease progression. Statistical analysis was performed using the R programming language. The survival analysis compared patients treated with the three groups and who received first-generation combined targeted bevacizumab with single T. Subgroup analysis was performed for each factor. Results The study included a total of 822 patients, comprising 308 males (36.2%) and 542 females (63.8%), with ages ranging from 26 to 88 years (mean age of 58.9 ± 11.0 years). A total of 591 cases were group T, 152 cases were TC, and 107 cases were TB. The five-year survival of TB (78.5%, 95% CI: 0.625–0.985) was found to be significantly higher than TC (63.1%, 95% CI: 0.54.7-0.728) and T (44.1%, 95% CI: 0.387–0.503). Subgroup analysis revealed that among patients with stage IV adenocarcinoma of the lung with EGFR-sensitive mutations, women (p = 0.05), ≤ 65 years old (p = 0.05), no history of hypertension (p = 0.04), no history of diabetes (p = 0.04), no history of smoking (p = 0.05), smoking index ≤ 200 years (p = 0.04), and no brain metastasis (p = 0.05) who treated with TB experienced a survival advantage. The combination of bevacizumab with first-generation targeted drugs demonstrated superior efficacy compared to first-generation and third-generation targeted drugs (HR = 1.63, 95% CI: 1.47–1.81, p < 0.0001). Conclusion In patients diagnosed with stage IV adenocarcinoma of the lung with EGFR-sensitive mutations, TB demonstrates superior efficacy compared to TC and T. Furthermore, the efficacy of first-generation targeting combined with bevacizumab surpasses that of single targeting.