之前的研究显示，与单独应用厄洛替尼（单药疗法）相比，贝伐单抗和厄洛替尼的联合治疗（联合疗法）显著延长了EGFR突变非小细胞肺癌（NSCLC）晚期患者的无进展生存期（PFS），但没有延长总生存期（OS）。2021年已有两项三期随机对照试验（RCTs）报道了OS结果。本次荟萃分析旨在纳入这两项RCT的结果以做出决策。我们系统地搜索了与应用贝伐单抗和厄洛替尼治疗EGFR突变NSCLC相关的RCT数据库。感兴趣的主要结果包括PFS、OS和报告的危险比（HR）。我们使用固定效应模型来估计合并的HR。总计有5份RCTs纳入本次荟萃分析，共计935名患者符合条件。所有研究均达到了主要研究终点，包括PFS和OS。与单药治疗相比，联合疗法显著延长了PFS（HR = 0.60，95％置信区间CI 0.51-0.70；p < 0.00001）；然而，两组之间的OS相似（HR = 0.90，95％CI 0.76-1.08；p = 0.26）。亚组分析显示，在19内删减突变亚组中，联合疗法只能延长PFS（HR = 0.60, 95% CI 0.47-0.76; p < 0.0001），但无法延长OS（HR = 1.00, 95% CI 0.73-1.37; p = 1.00），在21号外显子亮氨酸-精氨酸替代突变（L858R）亚组中也是如此（HR = 0.59, p < 0.0001 and HR = 0.80, p = 0.18，分别）。对于基线存在脑转移的患者，联合疗法的PFS显著优于单药疗法（HR = 0.60, 95% CI 0.39-0.90; p = 0.01），并且OS更好，差异边缘显著（HR = 0.69, 95% CI 0.46-1.02; p = 0.06）。 贝伐单抗和厄洛替尼的联合应用可延长EGFR突变非小细胞肺癌患者的无进展生存期，但并不能延长总生存期，与厄洛替尼单药治疗相比。联合疗法不仅可延长无进展生存期，而且对于基线存在脑转移的患者，延长总生存期的趋势也较明显。 © 2023. BioMed Central Ltd., part of Springer Nature.

Previous studies showed that the combination of bevacizumab and erlotinib (combination therapy) significantly prolonged progression-free survival (PFS) but no overall survival (OS) compared to erlotinib alone (monotherapy) for advanced EGFR-mutant non-small cell lung cancer (NSCLC). Two phase III randomized controlled trials (RCTs) had reported the OS results in 2021. This meta-analysis aimed to include the results of the two RCTs to make a decision.We systematically searched relevant databases for RCTs on the use of bevacizumab plus erlotinib in advanced EGFR-mutant NSCLC. The main outcomes of interest were PFS, OS, and the reported hazard ratio (HR). Fixed-effect model was used to estimate pooled HR.Total 5 RCTs with 935 patients were eligible for this meta-analysis. All studies reached their primary study endpoints including PFS and OS. Compared to monotherapy, combination therapy remarkably prolonged PFS (HR = 0.60, 95% confidence interval CI 0.51-0.70; p < 0.00001); however, OS was similar between the two groups (HR = 0.90, 95% CI 0.76-1.08; p = 0.26). Subgroup analysis demonstrated that in deletion within exon 19 (19del) mutation subgroup, the combination therapy could only prolong PFS (HR = 0.60, 95% CI 0.47-0.76; p < 0.0001) but not OS (HR = 1.00, 95% CI 0.73-1.37; p = 1.00), and also in leucine-to-arginine substitution in exon 21 (L858R) mutation subgroup (HR = 0.59, p < 0.0001 and HR = 0.80, p = 0.18, respectively). For patients with brain metastasis at baseline, the combination therapy achieved a significant better PFS than the monotherapy (HR = 0.60, 95% CI 0.39-0.90; p = 0.01), and a better OS with the difference marginally significant (HR = 0.69, 95% CI 0.46-1.02; p = 0.06).Combination of bevacizumab and erlotinib can prolong progression-free survival but not overall survival compared to erlotinib alone in advanced EGFR-mutant non-small cell lung cancer patients. The combination therapy not only can prolong progression-free survival but also has a tendency to prolong overall survival for patients with brain metastasis at baseline.© 2023. BioMed Central Ltd., part of Springer Nature.