Efficacy Of PD-1 Inhibitors In Combination With Different Anti-Angiogenic Agents In Non-Small Cell Lung Cancer

Research Background :In the world,Lung cancer is the most deadly malignancy.in 2020,about 1.79 million patients dying of lung cancer around the world.to lung cancer,the incidence and lethality rate was ranks first among male tumors in China.Surgery is the preferred treatment option for early-stage lung cancer,but because the early clinical manifestations of lung cancer are not obvious,or only cough and sputum and other cold-like symptoms,which are not easy to attract patients’ attention.Therefore,advanced lung cancer accounts for the majority,Drug therapy is the main tool for lung cancer.Recently,Immune checkpoint inhibitors are often used in combination with anti-angiogenic drugs for antitumor therapy as booster drugs,and many studies have found that the two have synergistic anti-tumor effects,and the combination can reduce drug resistance problems.Several clinical trials of ICIs in combination with anti-angiogenic drugs have reported the efficacy and safety of the two drugs in the treatment of non-small cell lung cancer(NSCLC).There are three types of anti-angiogenic drugs in common use,and the efficacy of ICIs in combination with different types of anti-angiogenic drugs in the treatment of NSCLC needs to be further verified.Objective:the safety and efficacy of programmed death receptor 1(PD-1)inhibitors combined with anti-angiogenic drugs on NSCLC will be assessed in this study,and we will to compare whether there are differences in the validity and safety of PD-1inhibitors combined with many kind anti-angiogenic drugs in the treatment of NSCLC,so as to provide a reference scheme for the clinical use of PD-1 inhibitors combined with anti-angiogenic drugs for the treatment of NSCLC.Methods:The patients will be chosen who visited the First Affiliated Hospital of Nanchang University from September 1,2020 to February 28,2022,were pathologically diagnosed with NSCLC and had received at least 2 cycles of PD-1 inhibitors combined with anti-angiogenic drugs.The clinical data of the patients were compiled and analyzed,mainly including the patients’ basic information such as gender,age,surgical history and smoking history,and combined the patients’ pathological type and clinical stage of lung cancer,chest CT,distant metastasis of lung cancer,adverse reactions after drug administration,treatment plan and the number of lines of drug administration to evaluate the clinical efficacy and concomitant adverse reactions after drug administration.The clinical efficacy and adverse reactions of the patients after medication were observed.evaluating the efficacy refer to the efficacy evaluation criteria for solid tumors(RECIST1.1),and the evaluation of toxic and side effects was based on the evaluation criteria for common adverse events version 4.0.The main observation indexes included: objective remission rate(ORR),disease control rate(DCR)and adverse events(AEs).Results:1.there is 102 patients in the study.After treatment,all patients did not achieve complete remission;25(24.5 %)patients were as sessed as partial response(PR)after treatment,the ORR was 24.5%,and the DCR was 89.2%.Among them,37 people in the first-line group,18(48.6)were assessed as PR after treatment,with ORR of 48.6% and DCR of 97.3%.There were 65 patients in the poster ior line group,7(10.8 %)of whom achieved PR after treatment,and the ORR and DCR were 10.8% and 84.6%respectively.Comparing the ORR and DCR in the first-line and post-line groups,the difference was statistically significant in the former(P < 0.05),while there was no significant diffe rence in the latter(> 0.05).but the DCR was no significant differences(p>0.05).The ORR and DCR of the adenocarcinoma group were 19.6% and 85.7%,and the squamous cell carcinoma group were 30.4% and 43%,Comparing ORR and DCR in th e adenocarcinoma and s quamous carcinoma groups,the differences were not statistically significant.2.PD-1 inhibitor combined with endostar,anlotinib and bevacizu mab were used to treat NSCLC.The ORR of the endostar,anlotinib and bevacizumab groups was 26.5%,30.0% and 14.3% respectively,and and the DCR was 79.4%,92.5% and 96.4% respec tively.The ORR and DCR were not statistically different among the three treatment groups.Meanwhile,by comparing the data,we found that there was a litter difference but no statistical signi ficant in ORR and DCR for NSCLC treated with PD-1 inhibitors combination with endostar,anlotinib,and bevacizumab in either the first-line or post-line groups,respectively.However,comparing the ORR and DCR of different dr ugs in first-line and post-line,it was found that the first-line ORR of PD-1 inhibitors combined with endostar,anlotinib and bevacizumab for non-small cell lung cancer was higher than the post-line,the difference was obvious and statistically significant;when comp aring the DCR of the three drugs in first-line and post-line,the difference was insignificant and not statistically significant.3.In the adenocarcinoma gr oup,the number of people who used endostar,anlotinib and bevaci zumab were 10、 18 and 28.After treatment,the ORR of the three drugs were 0.0% 、 38.9% and 14.3%,with no significant difference.The DCR of three drugs in the treatment of adenocarcinoma was 40.0% 、 94.9% and 96.4%.For the treatment of NSCLC,the DCR of PD-1 inhibitor combined with endostar was lower than that of PD-1 inhibitor combined with anlotinib or bevacizumab,the difference was significant and with statistical significance,but there was hardly difference between anlotinib and bevacizumab.Among the patients with squamous cell carc inoma,the number of pat ients who used endostar,anlotinib and bevacizumab was 24 、 22 and 0.In the squamous cell carcinoma group,the ORR and DCR of PD-1 inhibitor combined with endostar and anlotinib were 37.5%、22.7% and 95.8%、90.9%.Comparing the curative effects of two different treatment schemes in squamous cell carcinoma,there was hardly difference between ORR and DCR.4.there was 73 patients who had adverse reactions in the course of treatment,the grade three adverse reactions has 11 case,there is no grade4-5 adverse reactions,and no termination of treatment due to adverse reactions.Conclusion:1.PD-1 inhibitor combined with antiangiogenic drugs has considerable curative effect and good tolerance in the treatment of NSCLC.2.The first-line PD-1 inhibitor combined with antiangiogenic drugs is more effective in the treatment of NSCLC.3.PD-1 inhibitor combined with anlotinib and bevacizumab can make adenocarcinoma patients obtain higher DCR than PD-1 inhibitor combined with endostar;4.When PD-1 inhibitor combined with endostar,anlotinib and bevacizumab were used to treat NSCLC,There was no significant difference in curative effect and safety.