Abstract
Purpose: The combination of anlotinib with immune checkpoint inhibitors (ICIs) has become a common treatment modality in clinical practice. However, the optimal dose of anlotinib to use remains unclear.
Methods: We collected patients with advanced non-small cell lung cancer (NSCLC) who received programmed cell death-1 (PD-1) or programmed cell death ligand 1 (PD-L1) blockade combined with different dose anlotinib as second-line or later line therapy. Subsequently, the efficacy and safety of the combination therapy as well as subgroup analyses of different doses of anlotinib were analyzed. Cox regression was performed to analyze significant factors correlated with progression-free survival (PFS) and overall survival (OS).
Results: A total of 50 eligible patients with NSCLC who received anlotinib combined with ICIs therapy were included, of which 27 received low-dose anlotinib (8 mg), and 23 were administered high-dose anlotinib (12 mg). The median PFS (mPFS) and the median OS (mOS) for all patients were 8.3 months (95% CI 6.3–10.3) and 17.6 months (95% CI 16.5–18.7), respectively. Subgroup analyses showed that patients treated with 8 mg of anlotinib plus ICIs had significantly longer mPFS than those treated with 12 mg of amlotinib plus ICIs (8.7 months vs 6.7 months; p=0.016). The overall incidence of adverse events (AEs) was 68.0%, and the most common AEs of all grades were hypertension. Meanwhile, the incidence of adverse events was higher for 12 mg of anlotinib plus ICIs than that of 8 mg of anlotinib plus ICIs(82.6% vs 55.6%, P = 0.041).
Conclusion: Low-dose anlotinib in combination with ICIs for advanced NSCLC may be an effective and well-tolerated option.