Abstract
BACKGROUND: Atezolizumab plus bevacizumab, carboplatin, and paclitaxel (ABCP) therapy demonstrated superior efficacy in advanced non-squamous non-small cell lung cancer (NSCLC) in the IMpower150 trial. However, real-world evidence on ABCP therapy remains limited. This study aimed to assess the real-world efficacy and safety of ABCP as first-line treatment for advanced non-squamous NSCLC. METHODS: We retrospectively evaluated patients with advanced non-squamous NSCLC who received first-line ABCP therapy at our hospital between February 2019 and December 2021. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier methods. Objective response rate (ORR) and disease control rate (DCR) were used to evaluate the response. RESULTS: A total of 28 patients receiving first-line ABCP were included in the efficacy analysis. The ORR and DCR were 50.0% and 92.9%, respectively. The ORR for PD-L1 [tumor population score (TPS)] ≥50%, 1-49%, and <1% was 66.7%, 50.0%, and 33.3%, respectively, while the DCR for these groups was 100%, 90.0%, and 88.9%. Patients with TPS ≥50% had significantly better OS compared to those with TPS <50% (not reached vs. 21.2 months, P=0.04). Although PFS demonstrated a favorable trend, the difference was not statistically significant (9.7 vs. 8.3 months, P=0.07). Notably, patients with TPS <50% still achieved a high DCR and favorable survival outcomes, exceeding prior immunotherapy combination regimens. Treatment-related adverse events (TRAEs) were observed in 96.4% of patients, with grade 3-4 TRAEs in 78.6%. Hematologic toxicities were most frequent, while pneumonitis was reported in only 1 patient (3.6%), and no treatment-related deaths occurred. CONCLUSIONS: This study confirms the real-world efficacy and safety of ABCP therapy in patients with advanced non-squamous NSCLC. The regimen demonstrated robust tumor control across PD-L1 subgroups. The favorable safety profile, including a low incidence of pneumonitis, supports ABCP therapy as a promising treatment option with broad clinical applicability.