Toripalimab and anlotinib as a maintenance treatment for extensive-stage small-cell lung cancer: a case report

Anlotinib as a Tailored Treatment for Extensive-Stage Small Cell Lung Cancer with Stable Disease after Two Cycles of First Chemotherapy Plus Immunotherapy: A Retrospective Study

Objective: Optimize the treatment of extensive-stage small cell lung cancer (ES-SCLC). Materials and Methods: We collected data on patients with ES-SCLC who had stable disease (SD) after two cycles of first-line chemotherapy combined with immunotherapy (CIO) and subsequently received tailored treatment with anlotinib. The primary endpoints of the study were progression-free survival and overall survival (OS), while secondary endpoints included overall response rate (ORR), disease control rate (DCR), and adverse events (AEs). Results: A total of 45 patients were ultimately enrolled in the study. Preliminary analysis indicated that the integration of anlotinib provides promising efficacy for patients with ES-SCLC who had SD after two cycles of CIO. ORR and DCR were 26.67% and 62.22%, respectively, with median progression-free survival and median OS were 6.0 months and 10.0 months. Furthermore, subgroup analysis results showed that patients who experienced hypertension, proteinuria, and hand-foot syndrome during treatment had better efficacy. In addition, mechanistic analysis suggested that this regimen may activate the immune system by depleting immune suppression, thereby exerting a synergistic antitumor effect. Beyond the promising efficacy, the overall AEs of this regimen were manageable, indicating a potential positive outlook for this treatment model in this patient population. Conclusion: The adaptive treatment with anlotinib can significantly improve outcomes for these patients, with manageable toxicities, suggesting that this treatment model has the potential to become an important option for first-line therapy in ES-SCLC. However, its true clinical value requires further research for validation.

Comparative efficacy and safety of first-line neoadjuvant therapy for early-stage non-small cell lung cancer based on immune checkpoint inhibitor therapy: a systematic review and network meta-analysis

INTRODUCTION

Although there are a number of neoadjuvant immunotherapy combinations that can be applied to the treatment of perioperative non-small cell lung cancer patients, the optimal treatment combination strategy has not yet been determined.

METHODS

We searched PubMed, EMBASE, Cochrane Library, ClinicalTrials.go and randomised controlled trials (RCTs) from major international conferences for literature related to neoadjuvant immunotherapy combinations published as first-line treatment options for non-small cell lung cancer from the start of the library to 20 February 2024, and performed a systematic review and network meta-analysis.

RESULTS

We analyzed nine studies involving 3431 patients, including eight perioperative neoadjuvant immunotherapy combinations for non-small cell lung cancer. For patients without programmed death-ligand 1(PD-L1) selection, Toripalimab plus chemotherapy provided the best Pathological complete response (PCR) benefit (OR = 32.89,95% CI:7.88-137.32), best Major Pathological response (MPR) benefit (OR = 10.25, 95% CI: 5.81-18.10) and best Event-free survival (EFS) benefit (HR = 0.40,95% CI: 0.28-0.57). Nivolumab plus chemotherapy provided the best surgical resection rate (OR = 1.71, 95% CI:0.87-3.40) and pembrolizumab plus chemotherapy provided the best R0 surgical resection rate (OR = 2.20, 95% CI:1.28-3.79). In contrast, the combination of ipilimumab, nivolumab and chemotherapy, and the combination of toripalimab and chemotherapy were associated with the lowest incidence of adverse events of grade 3 or above during neoadjuvant therapy.

CONCLUSIONS

Our findings suggest that: Toripalimab plus chemotherapy showed better neoadjuvant efficacy and may have an overall survival benefit, but also increased the incidence of serious adverse events during neoadjuvant therapy.

Comparison of the efficacy and safety of anlotinib monotherapy or anlotinib plus immune checkpoint inhibitor for advanced small cell lung cancer with brain metastases

BACKGROUND

Anlotinib, as a salvage treatment for patients after failure of third-line or later-line treatments for small cell lung cancer (SCLC), has shown efficacy in patients with brain metastases (BMs). However, the efficacy and safety of anlotinib alone or in combination with immunotherapy for SCLC with BMs remain unclear.

METHOD

Patients treated with anlotinib alone or in combination with an immune checkpoint inhibitor (ICI) at the Zhejiang Cancer Hospital between April 2019 and February 2023 were identified. Kaplan-Meier curves were used to describe the progression-free survival (PFS) and intracranial PFS (iPFS). A waterfall diagram was used to indicate changes in intracranial lesions.

RESULTS

A total of 48 patients were included; 29 received anlotinib alone, and 19 were administered anlotinib plus ICI. Combination therapy, compared with anlotinib, was associated with significantly longer PFS and iPFS (PFS: 8.1 months vs. 2.5 months, P < 0.001; iPFS: 8.1 months vs. 2.5 months, P = 0.004). Similar results were observed in patients with multiple BMs (PFS: 8.1 months vs. 1.9 months, P = 0.001; iPFS: 8.1 months vs. 1.9 months, P = 0.002). After third-line or later-line treatments, patients treated with ICI plus anlotinib also achieved significant PFS and iPFS benefits (PFS: 8.4 months vs. 2.1 months, P < 0.001; iPFS: 9.2 months vs. 2.1 months, P = 0.002). No new or severe adverse events were observed with combination therapy.

CONCLUSION

The combination of anlotinib and ICI has promising intracranial and extracranial efficacy with tolerable toxicity, and may be a therapeutic option for SCLC patients with BMs.

An unusual case of immune-related gastritis in one patient receiving toripalimab therapy

PD-1 inhibitors contribute to immune response against malignancies. These drugs also result in serial side effects. Here the authors report a case of immune-related gastritis induced by PD-1 inhibitor. A female with metastatic lung cancer developed severe epigastric pain and acid reflux during treatment with toripalimab. She underwent several gastroscopies, which showed progressively worse gastritis. After discontinuing toripalimab, those symptoms were resolved. This rare report highlights gastritis associated with toripalimab, describes the symptoms and histology features and records the progression of this side effect and the corresponding treatment. Based on the improvement after toripalimab withdrawal, the authors believed that she had autoimmune gastritis caused by toripalimab. This case reminds us that correct diagnosis and proper management are critical to patients undergoing treatment with PD-1 inhibitors.