Efficacy of cisplatin/pemetrexed with bevacizumab to treat advanced lung adenocarcinoma with different drive genes: case report and literature review

Figures & data

Figure 1 Case 1.

Notes: (A) Prior to therapy, chest CT scan shows a primary mass (arrow) in the right lung. (B) After two cycles of therapy, chest CT scan shows significant shrinkage of the mass (arrow). (C) After four cycles of therapy, chest CT scan shows further shrinkage of the mass (arrow), although not obvious.
Abbreviation: CT, computed tomography.

Table 1 Clinical characteristics of different patients during the course of treatment

Variable	Case 1	Case 2	Case 3
Age, years	69	52	58
Sex	Male	Female	Female
Stage	IV	IV	IV
Smoking	Yes	No	No
Primary tumor size (cm)
Before treatment	6.0×4.7	1.8×1.2	2.7×2.3
After two cycles of therapy	4.4×3.7	Show not clear	1.8×1.0
After four cycles of therapy	4.2×3.3	Show not clear	1.0×0.7
Pathological type	Adenocarcinoma	Adenocarcinoma	Adenocarcinoma
Gene type
EGFR	Wild type	Wild type	Exon 19 mutation
ALK	Negative	Positive	Negative
CEA (ng/mL)
Before treatment	419.2	119.9	8.62
After two cycles of therapy	244.9	25.03	3.48
After four cycles of therapy	189.2	14.63	1.72
Response
After two cycles of therapy	PR	CR	PR
After four cycles of therapy	SD	SD	SD

Abbreviations: EGFR, epidermal growth factor receptor; ALK, anaplastic lymphoma kinase; CEA, carcinoembryonic antigen; PR, progressive disease; CR, complete response; SD, stable disease.

Figure 2 Case 2.

Notes: (A) Prior to therapy, chest CT scan shows a major lung nodule (arrow) in the right lung. (B) After two cycles of therapy, chest CT scan shows significant shrinkage of the mass (arrow). (C) After four cycles of therapy, chest CT scan shows further shrinkage of the mass (arrow).
Abbreviation: CT, computed tomography.

Figure 3 Case 2.

Notes: (A) Prior to therapy, brain MRI scan shows major brain metastasis nodules (arrow). (B and C) After two or four cycles of therapy, brain MRI scan shows significant shrinkage of the major brain metastasis nodules (arrow).
Abbreviation: MRI, magnetic resonance imaging.

Figure 4 Case 3.

Notes: (A) Prior to therapy, chest CT scan shows a major lung mass (arrow) in the right lung. (B) After two cycles of therapy, chest CT scan shows significant shrinkage of the mass (arrow). (C) After four cycles of therapy, chest CT scan shows further shrinkage of the mass (arrow).
Abbreviation: CT, computed tomography.

Table 2 Randomized controlled trials of bevacizumab plus chemotherapy

Study ID	Published year	Chemotherapy regimens	Results	Research type
Sandler et al^Citation14	2006	Paclitaxel/carboplatin	The median survival was 12.3 months and 10.3 months (P=0.003). The median PFS was 6.2 months and 4.5 months (P<0.001)	Prospective study
Reck et al^Citation15	2009	Cisplatin/gemcitabine	The PFS was 6.7 months and 6.1 months (P=0.003)	Prospective study
Reynolds et al^Citation16	2009	Paclitaxel/carboplatin	Median PFS was 9.8 months, and median survival was 16.8 months	Prospective study
Crinò et al^Citation17	2010	Platinum-based chemotherapy	Confirm the manageable safety profile of first-line bevacizumab in combination with various standard chemotherapy regimens	Prospective study
Niho et al^Citation18	2012	Carboplatin/paclitaxel	The median PFS was 6.9 months and 5.9 months (P=0.0090). Median OS was >22 months in both treatment groups (P=0.9526)	Prospective study
Zhou et al^Citation19	2015	Carboplatin/paclitaxel	OS was 24.3 months and 17.7 months (P=0.0154). Median PFS was 12.4 months and 7.9 months (P<0.001)	Prospective study
Mir et al^Citation23	2012	Pemetrexed/oxaliplatin	The median PFS and OS were 6.2 months and 14.6 months, respectively	Prospective study

Abbreviations: PFS, progression-free survival; OS, overall survival.

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