The efficacy and safety of anlotinib in bevacizumab-pretreated patients with non-squamous non-small cell lung cancer (AN-BELIEF study)

Background With the increasing progression of bevacizumab and the urgent need for anti-angiogenic strategies, we aimed to evaluate the efficacy and safety of anlotinib in bevacizumab-pretreated patients with non-squamous non-small cell lung cancer. Methods This was a retrospective real-world study. We enrolled bevacizumab-naïve patients and bevacizumab-pretreated patients from six hospitals during Jan 2018 and May 2024. Progression-free survival (PFS) was the primary outcome. Secondary outcomes included objective response rate (ORR), disease control rate (DCR) and safe outcome. Results A total of 1256 patients were screened, and 746 patients were included in the study. Firstly, we selected patients treated with anlotinib monotherapy. After propensity score matching (PSM), we divided them into beva-pretreated (n = 73) and beva-naïve group (n = 146), and no statistical differences were observed in PFS (6.43 vs. 7.60 months; HR 1.14, p = 0.334). So previous bevacizumab didn't affect the efficiency of anlotinib in non-squamous NSCLC. We further divided the bevacizumab-pretreated patients into three groups according to the post-treatment: anlotinib monotherapy (n = 108), anlotinib combination (n = 345), and other therapies (n = 119). After PSM, the PFS was similar between the anlotinib monotherapy (n = 93) and other treatment group (n = 93) (5.90 vs. 5.23 months; HR 0.96, p = 0.766), whereas the PFS was significantly longer in the anlotinib combination group (n = 297) than other treatment group (n = 99) (6.50 vs 5.23 months; HR 0.82, p = 0.048). Conclusion This study demonstrated that previous bevacizumab didn't affect the efficiency of anlotinib in non-squamous NSCLC. For beva-pretreated patients, combined with anlotinib was effective and well-tolerated. Further studies are warranted to confirm these results and explore the potential advantages of anlotinib.