To investigate the efficacy and safety of different doses of bevacizumab combined with pemetrexed and platinum-based chemotherapy as first-line treatment for advanced non-squamous non-small cell lung cancer (NSCLC).

Data from 76 patients with advanced non-squamous NSCLC treated with bevacizumab combined with pemetrexed and platinum-based regimens admitted to our hospital between September 2021 and December 2025 were selected. Among them, 45 patients received the low-dose group (7.5 mg/kg) and 31 patients received the high-dose group (15 mg/kg). Propensity score matching (PSM) was used to randomly assign 28 patients to each group at a 1︰1 ratio. Objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse reactions were compared between the two groups. Survival curves were plotted using the Kaplan-Meier method, and survival differences were compared using the Log-rank test. Cox regression was used for subgroup analysis.

Baseline characteristics were balanced between the two groups after PSM (P>0.05). ORR was 53.57% vs. 35.71% in the low-dose group (P=0.179), and DCR was 78.57% vs. 60.71% (P=0.146) in the high-dose group. Median OS was 24.5 months (95%CI: 19.324~29.676) vs. 22.8 months (95%CI: 17.512~28.088) in the low-dose group (HR=1.167, 95%CI: 0.540~2.519, Log-rank P=0.695). Subgroup analysis showed no significant interaction between baseline characteristics such as age, sex, Eastern Cooperative Oncology Group Performance Status (ECOG PS), smoking history, pathological subtype, hypertension, chronic obstructive pulmonary disease (COPD), and KRAS mutation and dose-response relationship (P>0.05). Adverse reactions were predominantly grade 1~2 in both groups; there was no statistically significant difference in the incidence of grade ≥3 serious hematologic and non-hematologic toxicities between the groups (P>0.05). The incidence of grade 1~2 nausea/vomiting was higher in the low-dose group than in the high-dose group (42.86% vs. 17.86%, P=0.042), but no increase in grade ≥3 gastrointestinal toxicities (7.14% vs. 3.57%, P=0.553).

The efficacy of low-dose bevacizumab (7.5 mg/kg) combined with pemetrexed and platinum-based chemotherapy as first-line treatment for advanced non-squamous NSCLC is non-inferior to the standard dose (15 mg/kg), with similar adverse reaction risks and good safety profile.