Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2024; 16(8): 3521-3528
Published online Aug 15, 2024. doi: 10.4251/wjgo.v16.i8.3521
Efficacy of chemotherapy containing bevacizumab in patients with metastatic colorectal cancer according to programmed cell death ligand 1
Shin Woo Kang, Sung Hee Lim, Min-Ji Kim, Jeeyun Lee, Young Suk Park, Ho Yeong Lim, Won Ki Kang, Seung Tae Kim
Shin Woo Kang, Sung Hee Lim, Jeeyun Lee, Young Suk Park, Ho Yeong Lim, Won Ki Kang, Seung Tae Kim, Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Min-Ji Kim, Samsung Biomedical Research Institute, Samsung Medical Center, Seoul 06351, South Korea
Co-first authors: Shin Woo Kang and Sung Hee Lim.
Author contributions: Kang SW and Lim SH contributed to this article equally. Kim ST contributed to the conceptualization of this study; Kang SW and Lim SH participated in the formal analysis of this article; Lee J, Park YS, Lim HY, and Kang WK contributed to the investigation of this manuscript; Kang SW and Lim SH wrote-original draft; Kang SW, Lim SH, Kim MJ, Lee J, Park YS, Lim HY, Kang WK, Kim ST participated in the writing-review and editing.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB No. 2021-09-052-004) at Samsung Medical Center. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and the Korea Good Clinical Practice guidelines.
Informed consent statement: Individual consent for this analysis was waived. Patients in the database were identified by patient number only, and patient information was kept confidential according to the Institutional Review Board protocol.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4. 0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seung Tae Kim, MD, PhD, Professor, Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul 06351, South Korea. seungtae1.kim@samsung.com
Received: February 21, 2024
Revised: May 2, 2024
Accepted: June 11, 2024
Published online: August 15, 2024
Processing time: 168 Days and 23 Hours
Abstract
BACKGROUND

Bevacizumab, an anti-vascular endothelial growth factor (VEGF) monoclonal antibody, inhibits angiogenesis and reduces tumor growth. Serum VEGF-C, lactate dehydrogenase, and inflammatory markers have been reported as predictive markers related to bevacizumab treatment. Programmed cell death ligand 1 (PD-L1) could act upon VEGF receptor 2 to induce cancer cell angiogenesis and metastasis.

AIM

To investigate the efficacy of bevacizumab-containing chemotherapy in patients with metastatic colorectal cancer (CRC) according to the expression of PD-L1.

METHODS

This analysis included CRC patients who received bevacizumab plus FOLFOX or FOLFIRI as first-line therapy between June 24, 2014 and February 28, 2022, at Samsung Medical Center (Seoul, South Korea). Analysis of patient data included evaluation of PD-L1 expression by the combined positive score (CPS). We analyzed the efficacy of bevacizumab according to PD-L1 expression status in patients with CRC.

RESULTS

A total of 124 patients was included in this analysis. Almost all patients were treated with bevacizumab plus FOLFIRI or FOLFOX as the first-line chemotherapy. While 77% of patients received FOLFOX, 23% received FOLFIRI as backbone first-line chemotherapy. The numbers of patients with a PD-L1 CPS of 1 or more, 5 or more, or 10 or more were 105 (85%), 64 (52%), and 32 (26%), respectively. The results showed no significant difference in progression-free survival (PFS) and overall survival (OS) with bevacizumab treatment between patients with PD-L1 CPS less than 1 and those with PD-L1 CPS of 1 or more (PD-L1 < 1% vs PD-L1 ≥ 1%; PFS: P = 0.93, OS: P = 0.33), between patients with PD-L1 CPS less than 5 and of 5 or more (PD-L1 < 5% vs PD-L1 ≥ 5%; PFS: P = 0.409, OS: P = 0.746), and between patients with PD-L1 CPS less than 10 and of 10 or more (PD-L1 < 10% vs PD-L1 ≥ 10%; PFS: P = 0.529, OS: P = 0.568).

CONCLUSION

Chemotherapy containing bevacizumab can be considered as first-line therapy in metastatic CRC irrespective of PD-L1 expression.

Keywords: Bevacizumab; Colorectal cancer; Programmed cell death ligand 1 expression; First-line chemotherapy; Metastatic colorectal cancer

Core Tip: The efficacy of first line chemotherapy (FOLFOX or FOLFIRI) plus bevacizumab in metastatic colorectal cancer was not significantly different according to the status of tumor tissue programmed cell death ligand 1 (PD-L1) combined positive score. Further research regarding dual inhibition of the vascular endothelial growth factor and PD-L1/programmed death 1 axes in various tumor types including colorectal cancer is required.