Recently, a 70-year-old uncle was hospitalized due to a lung lump, the lesion was too large to operate on, and he was ready to puncture the pathology and do genetic testing. The family is full of expectations to be able to pair up with targeted drugs, and the result is very disappointing to everyone, neuroendocrine carcinoma, consider small cell carcinoma. Genetic testing was done, but there were no sensitive genetic mutations. Patients were advised to consider chemotherapy and immunotherapy, but family members and patients were very resistant to chemotherapy and eventually chose immunotherapy combined with the anti-angiogenic drug anlotinib.
Small cells have always been a difficult "bone" to gnaw, which is notorious in the lung cancer community, with a high degree of malignancy, rapid cell proliferation, and may metastasize everywhere in the early stages, especially like to run to the brain. About 70% of patients with small cell lung cancer have developed a broad stage (advanced stage) when diagnosed. It can be said that it is very rare that advanced small cell lung cancer can survive for more than 5 years. Most terminal patients survive for 1-2 years, even if they are actively treated.
With the development of anti-tumor vascular therapy and immunotherapy, more and more clinical researchers are exploring combination therapy strategies. The "double-ampere combination" for widespread small cell lung cancer is one of them. The so-called "double amphelation combination" is an anti-angiogenesis multi-target small molecule targeted drug allozinib combined with PD1 inhibitor pisaprizumab.
Anlotinib is a multi-target small molecule tyrosine kinase inhibitor (TKI) originally researched in China, which can fully act on VEGFR, PDGFR and FGFR related targets in the angiogenesis pathway, play an anti-tumor angiogenesis role, and improve the tumor microenvironment, enhance tumor immune response, and improve the efficacy of tumor immunotherapy.
Pianopribumab is a modified IgG1 subtype PD-1 inhibitor of the Fc segment that removes multiple effect functions mediated by the Fc segment of the antibody. This structural modification not only allows for tighter binding and long-lasting blocking of the PD-1/PD-L1 pathway to obtain powerful T cell activation activity, but also further improves the safety of immunotherapy.
Theoretically, anti-angiogenesis therapy can normalize the disordered blood vessels in the tumor microenvironment, which in turn facilitates the intervention of immune drugs and plays an anti-tumor role in synergy with immunotherapy. The combination of shuang'an has obtained good efficacy in previous advanced liver cancer studies. And reported on ASCO: anlotinib combined with piaprizumab in the first line treatment of advanced primary liver cancer patients showed good antitumor activity, objective response rate (ORR) of 24%, disease control rate DCR up to 84%.
In the field of small cell lung cancer, there have been several small sample clinical trials in the past, and one of the trial results showed that paemprilimab combined with anantinib was used for SCLC second-line treatment ORR42.86%, DCR 71.43%, median PFS 4.62 months, OS is not yet mature. This data is better than that of previous second-line chemotherapy and immunization. The most common grade 3 adverse reactions are hypertension and fatigue, no grade 4/5 AE occurs, and the overall safety is controllable.
In short, for patients with advanced small cell lung cancer who are unwilling to undergo chemotherapy, progress after chemotherapy, or have poor physical fitness and cannot tolerate chemotherapy, allotinib combined immunotherapy is a choice of efficacy and safety.