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Background  VEGF plays a key role in tumor angiogenesis and immunosuppression. VEGF‐blocking has proven beneficial for  EGFR  mutant and wild‐type nonsquamous non‐small cell lung cancer (nonsq‐NSCLC); however, the number of cycles and treatment line yielding the optimal benefit are unknown.    Methods  We retrospectively analyzed the data of 115 patients with advanced/metastatic nonsq‐NSCLC administered at least one cycle of bevacizumab. The number of bevacizumab cycles was treated as a time‐dependent covariate. Predictors of overall survival (OS) were investigated.    Results  Bevacizumab was used as first‐line treatment in 47 (40.9%) patients, with a median of five cycles (range: 1–31). Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio [HR] 4.78, 95% confidence interval [CI] 2.68–8.51;  P  < 0.001), wild‐type  EGFR  (HR 2.61, 95% CI 1.45–4.70;  P  = 0.001), and bleeding during bevacizumab treatment (HR 3.63, 95% CI 1.77–7.45;  P  < 0.001) were predictive of poor OS; the number of bevacizumab cycles and first‐line administration were not. In the wild‐type  EGFR  subgroup, the number of bevacizumab cycles (≥ 5 vs. 1–4) was associated with a significant OS benefit (HR 0.28, 95% CI 0.08–0.98;  P  = 0.044); first‐line administration also showed an OS benefit (HR 0.48, 95% CI 0.20–1.17;  P  = 0.105). A significant association between the number of cycles and  EGFR  status was identified ( P  = 0.046).    Conclusion  OS benefit is negatively affected by bleeding events in bevacizumab‐treated patients. Prolonged and early introduction of bevacizumab may provide an OS benefit for patients with wild‐type  EGFR  nonsq‐NSCLC.

thoracic cancer

Impact of prolonged and early bevacizumab treatment on the overall survival of  EGFR ‐mutant and  EGFR ‐wild type nonsquamous non‐small cell lung cancer