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VEGF-A blockade overcomes liver metastases resistance to chemoimmunotherapy in patients with advanced non-squamous NSCLC

jitc · 2026-06-23 · canonical JSON source

11 visible annotations · policy: published · automated confidence ≥ 75.00%

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Purpose Liver metastases (LMs) confer resistance to immune checkpoint blockade in advanced non-squamous non‐small cell lung cancer (ns‐NSCLC), likely through an immunosuppressive tumor microenvironment (TME). We hypothesized that vascular endothelial growth factor (VEGF)-A blockade, by remodeling the immunosuppressive TME, could restore the benefit of chemoimmunotherapy in LM+ patients. Here, we report the first comparative analysis of chemoimmunotherapy with and without bevacizumab specifically in this population.Experimental design Data were analyzed from the phase III IMpower130 and IMpower150 trials in treatment‐naïve, EGFR/ALK-wild‐type patients with ns‐NSCLC. Treatment arms included chemotherapy (CT), CT plus atezolizumab (CT+immunotherapy (IT)), CT plus bevacizumab (CT+antiangiogenic (AA)), and CT+IT+ AA, with LM as a stratification factor. Survival outcomes were assessed by Kaplan-Meier estimates and multivariate Cox regression analyses. Bulk and single‐cell RNA sequencing data were used to characterize the LM TME.Results Among 1,713 patients, 236 (13.8%) presented with LMs. In IMpower130, LM+ patients derived no overall survival (OS) benefit from CT plus IT (CT+IT) compared with CT alone (HR for OS: 1.05; 95% CI 0.63 to 1.73). In contrast, in IMpower150, the addition of bevacizumab to CT+IT (CT+IT+ AA) significantly improved progression-free survival (PFS; HR: 0.49) and OS (HR: 0.52) in LM+ patients—an effect not observed in patients without LM. Baseline transcriptomic exploratory analyses from IMpower150 revealed a myeloid-enriched, lymphocyte-depleted TME. Single-cell RNA sequencing further demonstrated VEGF-A/VEGFR-1/2 crosstalk between macrophages and endothelial cells, as well as an autocrine VEGF-A/VEGFR-1 loop within macrophages.Conclusion The addition of bevacizumab to chemoimmunotherapy was associated with improved survival in ns‐NSCLC specifically in patients with LMs. These hypothesis-generating findings suggest that the benefit may stem from disruption of VEGF-A-driven immunosuppressive signaling in the liver, but require prospective confirmation.