Bevacizumab Plus EGFR-TKIs vs EGFR-TKIs Alone for Advanced EGFR-Mutant NSCLC: A Meta-Analysis

Background: The goal of this comprehensive meta-analysis was to evaluate the efficacy and safety of combining Epidermal Growth Factor Receptor (EGFR)-tyrosine kinase inhibitors (TKIs) with bevacizumab vs EGFR-TKI monotherapy in advanced non–small-cell lung cancer (NSCLC) patients harboring EGFR-sensitizing mutations. Methods: From inception until October 2023, we retrieved eligible studies comparing EGFR-TKIs combined with bevacizumab to EGFR-TKI monotherapy for the treatment of NSCLC with EGFR-sensitizing mutations. These studies were obtained from databases including CNKI, Wanfang, CBM, VIP, PubMed, Embase, Cochrane Library, and Web of Science. The International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) registration number is 2023120059. Results: This meta-analysis of 14 randomized controlled trials demonstrated that the combination significantly improved key efficacy outcomes compared to monotherapy. Superior partial response (odds ratio OR = 1.33, P = .05), objective response rate (OR = 1.52, P = .005), and reduced disease progression (OR = 0.31, P = .009) were observed. Furthermore, it significantly enhanced 1-year PFS (OR = 2.04, P < .00001), 2-year PFS (OR = 1.38, P = .02), and 1-year overall survival (OR = 1.41, P = .04). The safety profile was manageable, with no significant increase in rash ( P = .72) or pneumonitis ( P = .16). Expected increases in diarrhea, hypertension, and proteinuria were observed. Conclusions: The combination of bevacizumab and EGFR-TKIs provides substantial short-to-medium-term survival benefits with an acceptable safety profile for patients with advanced EGFR-mutant NSCLC. These findings support its use as a valuable first-line treatment option for this population.