Bevacizumab (BEV) combination chemotherapies (CCTs) for patients (Pts) with high-risk factors of pulmonary hemorrhage (PH) in advanced non-small cell lung cancer (NSCLC)

Aim/Background

PH is a possible fatal adverse event in BEV CCTs. Some clinical-pathological-radiographic factors such as presence of massive hemoptysis, predominant squamous histology, and tumor invasion to central bronchus are known as high-risk factors of PH. Poorer prognosis is also suggested in Pts with these high-risk factors. There is little evidence on the efficacy and safety of BEV CCTs in Pts with high-risk factors of PH.

Methods

We retrospectively investigated clinical course of NSCLC Pts receiving BEV CCTs with or without high-risk factors of PH in our insititute. Board certified radiologist, respirologist, and oncologist reviewed radiological/endoscopic findings.

Results

Between April 2009 and March 2015, 202 NSCLC Pts underwent BEV CCTs. We identified 7 Pts with presence of hemoptysis, 11 including squamous component, 65 suspected with tumor invasion to central bronchus, 72 after thoracic radiation, 35 suspected with main vessel invasion, 16 with cavity, and 20 receiving anti-coagulant or -platelets. PH was confirmed in 6 (3.0%) of 202 Pts. Among these 6 Pts, grade 5 PH was suspected in one, and 5 were grade 2 PH. All these 6 PH Pts had tumor invasion to central bronchus, whereas PH was observed in 6 (9.2%) of 65 Pts with tumor invasion to central bronchus. Only 1 (1.4%) of 72 Pts after thoracic radiation (median, 60 Gy; and range, 30-70 Gy) had PH. Median overall survival (OS) of Pts with high-risk factor of PH was 30.5 (95% confidence interval [CI], 22.3-36.0) months, and that of those without 47.1 (95% CI, 28.4-66.2) months (p = 0.0237). In limited data on Pts without driver mutations, OS with high-risk factor of PH vs. that without was 22.1 (95% CI, 15.6-27.5) months vs. 25.8 (95% CI, 16.6-36.8) months (p = 0.7990).

Conclusions

Even in Pts with high-risk factors of PH, BEV CCT could be therapeutic options by taking risk and benefit into consideration. PH should be cared in cases with tumor invasion to central bronchus, whereas history of thoracic radiation was not associated with PH in our cohort. In Pts without driver mutations, BEV may contribute to better prognosis.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.