Camrelizumab plus chemotherapy in advanced non‐squamous non‐small cell lung cancer: Treatment response, survival pattern, and safety

Clinical efficacy and safety of sintilimab plus oral vinorelbine as first-line treatment for newly diagnosed stage IIIB-IV nonsmall cell lung cancer patients with performance status 2 or age ≥75 years

This study aimed to evaluate the efficacy and safety of sintilimab combined with oral vinorelbine in newly diagnosed patients with stage IIIb to IV nonsmall cell lung cancer (NSCLC) who had an Eastern Cooperative Oncology Group performance status (PS) of 2 or over 75 years of age during the initial treatment. This prospective single-center single-arm study enrolled patients with histologically confirmed NSCLC. Eligible patients were administered sintilimab and vinorelbine. The primary endpoint was progression-free survival (PFS), and the secondary endpoints included objective response rate (ORR) and disease control rate (DCR). Furthermore, this study assessed indicators of treatment response and safety. From September 2020 to December 2023, 60 eligible patients were enrolled in the Respiratory Department of Shanxi Cancer Hospital. Following treatment, PFS was 9.1 months, and ORR and DCR were 39.6 and 63.79%, respectively. In addition, there was a reduction in blood tumor marker levels and enhanced immune function. Adverse reactions had a relatively low incidence and primarily consisted of grade 1-2 cases. Sintilimab plus oral vinorelbine showed promising efficacy and safety as a first-line treatment strategy for patients with NSCLC with PS 2 or elderly patients. It also optimizes immune function in patients with NSCLC.

Camrelizumab-induced immune-related toxic epidermal necrolysis in lung adenocarcinoma: a case report and literature review

Toxic epidermal necrolysis (TEN) is a rare and serious skin reaction. This study reports a case of a patient with lung adenocarcinoma (LUAD) who developed severe TEN after 8 days of treatment with Camrelizumab monotherapy. The patient's condition was effectively relieved with high-dose corticosteroids and intravenous immunoglobulin therapy. The diagnosis and treatment of immune-related TEN are challenging. This is a rare and severe case of TEN associated with the use of Camrelizumab. Additionally, we provide an in-depth understanding of immune-related TEN, summarizing its characteristics and treatment progress through a literature review, aiming to provide reference for the clinical safe application of immune checkpoint inhibitors (ICIs).

Efficacy and safety of camrelizumab-based comprehensive treatment for non-small cell lung cancer: a systematic review and meta-analysis

Background

Many studies show that camrelizumab combination therapy can significantly improve progression-free survival (PFS) and overall survival (OS) in non-small cell lung cancer (NSCLC). However, the time of camrelizumab to market is short, and there is no systematic evaluation of camrelizumab-based comprehensive treatment of NSCLC.

Objectives

To systematically evaluate the efficacy and safety of camrelizumab in comprehensively treating NSCLC.

Design

A systematic review and meta-analysis.

Data sources and methods

Databases, including PubMed, Web of Science, Embase, and Cochrane, were searched by computer before August 2023 based on Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and reports on the efficacy and safety of camrelizumab-based treatment for NSCLC were collected, and RevMan 5.4 software was employed for meta-analysis finally.

Results

Totally, 5 RCTs, 2 cohort studies, and 12 single-arm studies were included. The meta-analysis results revealed that, compared with the treatment without camrelizumab, the camrelizumab-based combination treatment considerably extended the OS (hazard ratio (HR) = 0.60, 95% confidence interval (CI): (0.44-0.82), p < 0.01), PFS (HR = 0.42, 95% CI: (0.28-0.63), p < 0.01), and event-free survival (EFS) (HR = 0.55, 95% CI: (0.44-0.68), p < 0.01). The median objective response rate in single-arm studies was 41% (95% CI: 28%-53%), and the disease control rate was 84% (95% CI: 78%-89%). Furthermore, in terms of the occurrence of grades 3-5 adverse events, the incidence of neutropenia was lower in the camrelizumab combination group than in the control group, while the incidence of leukopenia and rash was higher than in the combination group, and no significant difference was revealed in the incidence of other adverse events. Among single-arm studies, the incidence of grades 3-5 adverse events did not exceed 10%.

Conclusion

Treatment combined with camrelizumab can effectively prolong OS, PFS, and EFS in NSCLC patients with good safety, camrelizumab combined with chemotherapy is an effective treatment option for NSCLC patients.

Hepatic cavernous hemangioma developed in non-small cell lung cancer patients after receiving Camrelizumab treatment: two case reports

Purpose

To report two cases of hepatic cavernous hemangioma, a rare complication, in patients with locally advanced and advanced non-squamous non-small cell lung cancer (NSCLC) treated with PD-1 inhibitors. Additionally, to share clinical experiences related to the management of this condition.

Methods

Two patients with locally advanced and advanced non-squamous non-small cell lung cancer (NSCLC) were enrolled in our hospital. Following the NCCN guidelines and expert consensus, both patients received standard treatment with Camrelizumab (PD-1 inhibitor). Subsequent abdominal CT scans revealed hepatic focal lesions that did not exhibit typical characteristics of metastatic tumors. Therefore, further systematic investigation was conducted to study the hepatic focal lesions.

Results

(1) Ultrasound-guided percutaneous biopsy confirmed the diagnosis of hepatic cavernous hemangioma. A multidisciplinary consultation concluded that it was an adverse drug reaction to Camrelizumab. (2) Ten-gene testing for both patients did not reveal any driver gene mutations associated with lung cancer. Apart from the occurrence of hepatic cavernous hemangioma, there were no signs of disease progression or worsening. (3) Both patients had resolution of hepatic cavernous hemangioma after switching to alternative PD-1 inhibitors or discontinuing PD-1 inhibitor treatment. One patient experienced hemorrhage related to the hepatic hemangioma, which was managed with hemostasis and symptomatic treatment, resulting in improvement. (4) Clinical outcomes: The first patient achieved a progression-free survival (PFS) of 33 months in first-line treatment and had not reached the PFS endpoint in second-line treatment, with an overall survival exceeding 56 months. The second patient had not reached the PFS endpoint in first-line treatment, with an overall survival exceeding 31 months.

Conclusion

Hepatic cavernous hemangioma is a rare and serious adverse reaction associated with PD-1 inhibitors. Camrelizumab may interact with the PD-1 molecule in a different manner compared to other PD-1 inhibitors, affecting the regulation of the VEGFR/ULBP2 signaling pathway. In future studies, next-generation sequencing may provide detailed molecular pathology information, which could help explain individual differences and provide a basis for the prevention or intervention of hepatic cavernous hemangioma.