Atezolizumab and Platinum Plus Pemetrexed With or Without Bevacizumab for Metastatic Nonsquamous Non–Small Cell Lung Cancer

作者：Yoshimasa Shiraishi, Junji Kishimoto, Shunichi Sugawara, Hideaki Mizutani, Haruko Daga, Koichi Azuma, Hirotaka Matsumoto, Osamu Hataji, Kazumi Nishino, Masahide Mori, Takehito Shukuya, Haruhiro Saito, Motoko Yoshikawa TACHIHARA, Hidetoshi Hayashi, Asuka Tsuya, Kazushige Wakuda, Noriko Yanagitani, Tomohiro Sakamoto, Satoru Miura, Akito Hata, Morihito Okada, Toshiyuki Kozuki, Yuki Sato, Taishi Harada, Koichi Takayama, Nobuyuki Yamamoto, Kazuhiko Nakagawa, Isamu Okamoto · 发表于：JAMA Oncology · 年份：2023 · DOI：10.1001/jamaoncol.2023.5258 · 被引用次数：54 · 研究领域：Lung Cancer Treatments and Mutations、Cancer Immunotherapy and Biomarkers、Lung Cancer Research Studies

Importance: The combination of an antibody to programmed cell death-1 (PD-1) or to its ligand (PD-L1) with chemotherapy is the standard first-line treatment for metastatic non-small cell lung cancer (NSCLC). Bevacizumab is expected to enhance the efficacy not only of chemotherapy but also of PD-1/PD-L1 antibodies through blockade of vascular endothelial growth factor-mediated immunosuppression, but further data are needed to support this. Objective: To evaluate the efficacy and safety of bevacizumab administered with platinum combination therapy and atezolizumab in patients with advanced nonsquamous NSCLC. Design, Setting, and Participants: An open-label phase 3 randomized clinical trial was conducted at 37 hospitals in Japan. Patients with advanced nonsquamous NSCLC without genetic driver alterations or those with genetic driver alterations who had received treatment with at least 1 approved tyrosine kinase inhibitor were enrolled between January 20, 2019, and August 12, 2020. Interventions: Patients were randomly assigned to receive either atezolizumab plus carboplatin with pemetrexed (APP) or atezolizumab, carboplatin plus pemetrexed, and bevacizumab (APPB). After 4 cycles of induction therapy, maintenance therapy with atezolizumab plus pemetrexed or with atezolizumab, pemetrexed, and bevacizumab was administered until evidence of disease progression, development of unacceptable toxic effects, or the elapse of 2 years from the initiation of protocol treatment. Main Outcome...