The safety and economic evaluation of bevacizumab and PD-1 inhibitors for advanced non- squamous NSCLC: a multicenter observational study in China

Abstract Background With the increasing number of indications approved for bevacizumab, evaluating its safety after marketing is essential. Besides, for patients with advanced non-squamous non-small-cell lung cancer (NSCLC), adding bevacizumab or PD-1 inhibitors to first-line doublet chemotherapy is routine. However, the optimal targeted therapy has yet to be defined. It is essential to discuss which scheme is safer, more effective, and more economical based on a comprehensive clinical evaluation. Methods The study utilized drug-based, non-invasive, observational, and uncontrolled methods to evaluate the safety of bevacizumab and was performed at six sites in China. By univariate and multivariate analysis, bevacizumab administration to inpatients with malignant tumors was studied for incidence and risk factors of adverse events (AEs). Moreover, the economic evaluation was conducted by comparing bevacizumab with PD-1 inhibitors through cost-effectiveness analysis. Results During a safety evaluation study of bevacizumab, a target population of 533 patients was assessed and it was found that AEs occurred in 86.26% of clinical cases. Anemia was the most common AE, accounting for 28.33% of cases. 26.45% of AEs were grade 3 or higher. The blood and lymphatic system had the highest incidence of severe AEs, followed by the cardiovascular system. Hypertension was the most common severe AE, occurring in 3.75% of patients. The study identified certain risk factors for AEs induced by bevacizumab through multivariate analysis in clinical practice. In pharmacoeconomic evaluation, each one percentage point increase in 1-year disease control rate (DCR) associated with bevacizumab relative to PD-1 inhibitors was associated with an additional cost of ¥164.16 per treatment cycle in the first-line treatment of common mutation-negative advanced non-squamous NSCLC. Conclusions The safety profile of bevacizumab is well-established and manageable. PD-1 inhibitors offer more pharmacoeconomic advantages over bevacizumab in treating advanced non-squamous NSCLC without common mutations.