Ivonescimab Plus Chemotherapy versus Bevacizumab Plus Chemotherapy in EGFR-Mutant Lung Adenocarcinoma After EGFR-TKI Failure: A Two-Center Retrospective Real-World Propensity Score-Matched Study

Abstract

Objective To evaluate the efficacy and safety of ivonescimab plus chemotherapy versus bevacizumab plus chemotherapy in advanced EGFR-mutant lung adenocarcinoma after EGFR-TKI failure, and provide the first real-world head-to-head comparative evidence. Methods This two-center retrospective propensity score-matched (PSM) study enrolled 390 eligible patients, including 130 receiving ivonescimab plus chemotherapy and 260 receiving bevacizumab plus chemotherapy. A 1:1 PSM was performed to balance baseline confounders. The primary endpoint was progression-free survival (PFS). Results After PSM, 120 patients were included in each group with balanced characteristics. The ivonescimab group had significantly longer median PFS (7.6 vs 5.9 months, HR=0.77, 95% CI 0.60–0.997, P=0.042) and overall survival (18.0 vs 15.1 months, HR=0.72, 95% CI 0.56–0.94, P=0.010), as well as higher objective response rate (45.0% vs 28.3%, P=0.007) and disease control rate (91.7% vs 81.7%, P=0.023). In exploratory subgroup analysis, patients with PD-L1 TPS≥50% derived the greatest benefit. Safety profiles were comparable between groups. Multivariate analysis confirmed ivonescimab plus chemotherapy as an independent protective factor for both survival endpoints. Conclusion Compared with bevacizumab plus chemotherapy, ivonescimab plus chemotherapy prolongs survival with manageable safety in this population, and may serve as a potential second-line treatment option. However, given the retrospective observational design, these findings require further prospective validation.