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 a performance status (PS) of 3-4 generally do not tolerate chemotherapy well. Currently, there is no effective treatment plan for these patients, and those with a PS of 3 or higher are typically given best supportive care. Retrospective studies have indicated that immune checkpoint inhibitors (ICIs) are often ineffective for advanced NSCLC patients with a PS of 2 or higher, regardless of PD-L1 expression levels. However, recent research suggests that anti-angiogenic drugs may have immunomodulatory effects that enhance immune response.In this case, we report a 72-year-old male with driver-negative lung squamous cell carcinoma, respiratory failure, and other severe medical issues, resulting in a PS of 4. We administered nivolumab (an immune checkpoint inhibitor) in combination with anlotinib (an anti-angiogenic drug). After two months of this combined treatment, the patient showed improved PS and a partial response (PR). As of now, the patient has been on regular follow-up for over 13 months, with no signs of disease progression or distant metastasis. This successful outcome in a critically ill patient suggests a promising synergistic effect of combining immunotherapy with anti-angiogenesis therapy and highlights the AL3818 potential of this treatment approach for similar patients.