Albumin Paclitaxel Combined with Intrapleural Infusion of Bevacizumab + Lobaplatin for the Second-Line Treatment of Patients with Non-Squamous Non-Small Cell Lung Cancer

Abstract

Objective. To investigate the clinical efficacy and safety of albumin paclitaxel combined with intrapleural bevacizumab + lobaplatin for patients with non-squamous non-small cell lung cancer (NS-NSCLC) with malignant pleural effusion (MPE) and analyze prognostic factors. Methods. A total of 126 NS-NSCLC patients were included in the study. Control group with 64 cases received intrapleural infusion of lobaplatin + intravenous albumin paclitaxel, and treatment group with 62 cases received additional intrapleural bevacizumab perfusion. Analysis was performed by collecting data about MPE, progression-free survival (PFS), overall survival (OS), and scores of quality of life. Results. In the treatment and control groups, objective response rate (ORR) was 51.6% and 31.3% (χ2 = 5.39, P = 0.02 ), and disease control rate (DCR) was 91.9% and 71.9% (χ2 = 8.49, P = 0.004 ), respectively. The main adverse reactions (≥grade 3) in the treatment group were thrombocytopenia, peripheral neurotoxicity, proteinuria, neutropenia, and nausea/vomiting, and in the control group, they were weakness, nausea/vomiting, anemia, and peripheral neurotoxicity. In the control and treatment groups, the median PFS was 6.2 (95% confidence interval (CI): 5.86–6.56) and 5.1 (95% CI: 4.956–5.191), and the median OS was 14.4 (95% CI: 12.681–16.113) and 10.6 months (95% CI: 8.759–12.391). The score of quality of life for treated patients was significantly higher than those before treatment and the control group, and the parameters included general health status (GH), role physical (RP), body pain (BP), social function (SF), and vitality (VT); pH, CD4+/CD8+ values, and vascular endothelial growth factor (VEGF) in the pleural effusion significantly affected the PFS and OS ( P < 0.05 ). Bevacizumab administration in patients with bloody pleural effusion did not increase the risk of pleural hemorrhage. Conclusion. The combination of albumin paclitaxel and intrapleural bevacizumab + lobaplatin is effective and may reverse the adverse events in patients with NS-NSCLC and MPE. The change of CD4+/CD8+ ratio before and after treatment is an independent and prognostic factor for patients with NS-NSCLC and MPE.

Single‐cell transcriptomics reveal metastatic CLDN4+ cancer cells underlying the recurrence of malignant pleural effusion in patients with advanced non‐small‐cell lung cancer

“…These results indicated that the cancer cell cluster C1 was involved in the regulation of VEGFA interaction among pleural effusion cells. That could in a way explained the reason why many clinical studies focusing on VEGF ‐targeted therapy for NSCLC with MPE only received limited response 49,50 . Pseudo‐time analysis was performed on monocyte C2 and C3.…”

“…That could in a way explained the reason why many clinical studies focusing on VEGF ‐targeted therapy for NSCLC with MPE only received limited response. 49 , 50 Pseudo‐time analysis was performed on monocyte C2 and C3. The cell trajectory of C3 tended to differentiate into the terminal status (Figure 5D‐i ), where they up‐regulated the expression of Mannose Receptor C‐Type 1 ( MRC1 ) (Figure 5D‐ii ).…”