Nivolumab in combination with anlotinib achieved remarkable efficacy in a patient with driver-negative lung squamous cell carcinoma and PS of 4

Abstract

Patients with driver-negative non-small cell lung cancer (NSCLC) and performance status (PS) of 3-4 do not tolerate chemotherapy well. There is currently no suitable treatment plan, and best supportive care is offered to patients with PS of 3 or greater. Some retrospective studies have shown the poor efficacy of immune checkpoint inhibitors (ICIs) for advanced NSCLC patients with PS ≥2 regardless of PD-L1 expression. However, some recent studies suggest that the anti-angiogenic drug has an immunomodulatory effect and can enhance immune efficacy. Here, we report a 72-year-old male patient with a diagnosis of driver-negative lung squamous cell carcinoma with respiratory failure and other serious medical conditions, resulting in PS of 4. We tried administering nivolumab (immune checkpoint inhibitor, ICI) in combination with anlotinib (angiogenic inhibitor) treatment to the patient. After 2 months of combination treatment, improved PS and a partial response (PR) was observed. Presently, the patient is on regular follow-up for over 13 months without any evidence of disease progression or distant metastasis. Our successful treatment of this driver-negative lung squamous cell carcinoma patient provides optimistic data to support the synergistic effect of immunotherapy and anti-angiogenesis therapy, and also demonstrated the potential application of this treatment regimen in critically ill patients.

FGFR2-ERC1: A Subtype of FGFR2 Oncogenic Fusion Variant in Lung Adenocarcinoma and the Response to Anlotinib

“…Anlotinib increases infiltration of T cells, NK cells and APC cells, and the combination of anlotinib and immunotherapy has a synergistic effect. 30 , 31 In addition, anlotinib has been shown to have synergistic effects with chemotherapy and targeted therapies. 32 , 33 Adverse effects of anlotinib monotherapy have been shown to be manageable in previous studies.…”

International consensus on severe lung cancer—the first edition

“…The patient received combination therapy including endoscopic recanalization of central airway followed by immunotherapy, which reduced tumor lesions and improved the PS score (180). Case reports have shown that immunotherapy was also effective in patients with a PS of 4 (181,182). Nevertheless, the role of immunotherapy in patients with poor PS scores needs to be further investigated.…”