Abstract
PURPOSE: For patients with advanced nonsquamous non-small cell lung cancer (NSCLC), immunotherapy or antiangiogenic therapy combined with pemetrexed and cisplatin/carboplatin have both shown significant efficacy at programmed cell death ligand 1 (PD-L1) levels of <1%. Our study aimed to compare two first-line regimens for patients with advanced nonsquamous NSCLC who were negative for PD-L1. METHODS: A retrospective cohort study was conducted comparing the outcomes of patients with advanced PD-L1(-) nonsquamous NSCLC who were treated with antiangiogenic therapy plus chemotherapy (A Group) to those who were treated with anti-PD-L1 monoclonal antibodies plus chemotherapy (mAbs) (B Group). Both regimens were evaluated for progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and side effects. RESULTS: 114 patients were enrolled in the study, 82 in Group A and 32 in Group B. Those in Group A had a longer median PFS (9.8 vs. 6.7 months, p = 0.025). The OS was also achieved (p = 0.058). No statistically significant difference was seen in ORR (52.4% vs. 50.0%, p = 0.815) or DCR (93.9% vs. 87.5%, p = 0.225) between the two groups. Patients in the A group who did not smoke and did not have specific metastases could benefit from survival. Adverse events (AEs) in both groups were tolerated. CONCLUSION: Bevacizumab plus chemotherapy outperformed immunotherapy plus chemotherapy in terms of PFS.