Comparison Of The Efficacy And Safety Of ICIs With Rh-endostatin Versus ICIs With Chemotherapy For The Second-line Treatment Of Advanced NSCLC

Objective:Despite the fact that numerous clinical and preclinical studies have demonstrated the synergistic effects of combining antiangiogenic or chemotherapy with immunotherapy,no data have been found to indicate that combination therapy is more effective and safer as second-line therapy.Methods:We retrospectively compared the effectiveness and safety of ICIs plus rhendostatin to ICIs plus chemotherapy in patients with advanced non-small cell lung cancer(NSCLC)seen at xxx hospital from September 2019 to May 2022.There was also an exploratory analysis of effective predictors of combination treatment strategies for ICIs.The evaluation indicators were progression-free survival(PFS)and safety profile,overall response rate(ORR),disease control rate(DCR),and 1-year overall survival(OS).Results:The study included 88 NSCLC patients who received ICIs combination therapy as a second-line treatment.48 patients received ICIs plus chemotherapy,and 40 patients were treated with ICIs plus endostatin.At a median follow-up time of 16.7 months,the median PFS with immunotherapy plus rh-endostatin(IE)was 7.10 months versus 5.13 months with immunotherapy plus chemotherapy(IC)(P = 0.019).Treatment-related adverse events of grade 3 or 4 occurred in 7.5% of the IE group versus 25.0% of the IC group.The ORR in the IE group was 35.0% versus 20.8% in the IC group(P = 0.137),and the DCR in the IE group was 92.5% versus 77.1% in the IC group(P = 0.049).The1-year OS for the IE group was 69.4%,which was higher than the IC group’s rate of61.4%.High levels of LDH before and after treatment and low levels of ALC and PNI during treatment both had a negative impact on PFS in the combination therapy(P =0.006,P(27)0.001,P = 0.002,P = 0.027).Conclusion:1.Our study showed that ICI therapy combined with endostatin therapy exhibits high efficacy and safety,suggesting that such a combination might be a viable treatment option for patients with pre-treated NSCLC in the future.2.Dynamic changes in pre-treatment LDH levels,and LDH,ALC,and PNI during treatment were correlated with the efficacy of immune combination therapy.