Comparison of the Efficacy of Immune Checkpoint Inhibitors Combined with Chemotherapy Versus Bevacizumab Combined with Chemotherapy in Advanced Driver Gene-Negative Non-Squamous Non-Small Cell Lung Cancer: A Retrospective Study

Abstract

Objective: To compare the efficacy and safety of immune checkpoint inhibitors (ICIs) plus chemotherapy versus bevacizumab plus chemotherapy in advanced driver gene-negative non-squamous non-small cell lung cancer (NS-NSCLC). Methods: This retrospective cohort study included 199 patients treated from October 2015 to January 2022. Group A (n=103) received ICIs plus chemotherapy (pemetrexed + cisplatin), while Group B (n=96) received bevacizumab plus the same chemotherapy. Outcomes included treatment response, serum tumor markers (CEA, CA-125, CA-199), immunoglobulins (IgA, IgG, IgM), adverse reactions, and survival [progression-free survival (PFS), overall survival (OS)]. Results: Group A had a significantly higher objective response rate (59.22% vs 36.46%, P=0.001). Tumor marker levels decreased more in Group A (P<0.05), while declines in immunoglobulin levels were less pronounced (P<0.05). Adverse events were similar between groups (P>0.05). Group A had a longer median PFS (11.13 vs 7.37 months, P<0.05), and a non-significant trend toward longer OS (20.87 vs 18.4 months, P=0.159). Conclusion: ICIs combined with chemotherapy improved treatment efficacy and PFS compared to bevacizumab-based therapy in advanced driver gene-negative NS-NSCLC, with manageable safety and less impact on immune function.