Efficacy And Safety Analysis Of PD-1 Inhibitor Combined With Recombinant Human Endostatin And Chemotherapy In First-Line Treatment Of Advanced Non-small Cell Lung Cancer

Objective:This study retrospectively analyzed the efficacy and safety of PD-1 inhibitors in combination with recombinant human endostatin and chemotherapy in the first-line treatment of advanced non-small cell lung cancer(NSCLC),and explored the factors that might affect the prognosis of patients.Methods:A total of 865 patients with advanced NSCLC admitted to the Department of Oncology and Respiratory Medicine of the First Affiliated Hospital of Nanchang University from April 2019 to August 2021 were collected,and a total of 100 patients were screened out according to inclusion and exclusion criteria.Among them,58 patients treated with PD-1 inhibitor combined with Endostar and chemotherapy were in the treatment group(I+E+C group),and 42 patients in the Endostar combined with chemotherapy were in the control group(E+C group).The PD-1 inhibitor was one of Camrelizumab,Sintilimab and Tislelizumab,and the chemotherapy regimen was a two-drug regimen containing platinum.Objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS)and adverse events were compared between I+E+C group and E+C group.Results:The treatment group significantly improved the ORR(67.2% vs 42.9%,P=0.015)and significantly prolonged PFS(10.2 months vs 6.5 months,P < 0.001).The DCR and 1-year OS rate in the I+E+C group was higher than that in the control group,but the difference was not statistically significant(98.3% vs 90.5%,P=0.193;79.3% vs76.2%,P=0.710).Subgroup analysis of different PD-1 inhibitors in the treatment group showed that there was no statistically significant difference in the efficacy of the combined treatment group with domestic PD-1 inhibitors,and the type of PD-1inhibitor was not a potential predictor of ORR,DCR and PFS.In terms of survival time,patients with no bone metastasis,no brain metastasis,no liver metastasis,distant metastasis site < 2,clinical stage IIIB/C and group I+E+C had longer PFS.After multivariate analysis,no brain metastasis at baseline,clinical stage ⅢB/C,and group I+E+C were independent protective factors affecting PFS(HR=3.17,95%CI:1.33-7.53,P=0.009;HR=5.06,95% CI: 1.82-14.03,P=0.002;HR=0.48,95%CI: 0.36-0.63,P < 0.001).The incidence of interstitial pneumonia,reactive capillary hyperplasia and hypothyroidism in the I+E+C group was significantly higher than that in control group.In terms of total adverse events and grade 3 and above adverse events,there was no statistical significance between the two groups.Conclusions:1.PD-1 inhibitor combined with recombinant human endostatin and chemothera-py in first-line treatment of advanced NSCLC with negative driver gene can significantly improve ORR,and prolong PFS in patients with good safety.2.No brain metastasis at baseline,clinical stage ⅢB/C,and treatment with a PD-1 inhibitor combined with recombinant human endostatin and chemotherapy were independent protective factors affecting patients’ PFS.