To analyze the effect of anti-angiogenic drugs combined with programmed death 1 (PD-1) blockade on the treatment of non-small cell lung cancer (NSCLC) and T lymphocyte subsets.

A total of 64 patients with advanced stage (confirmed by pathology or cytology as stage ⅢB/ⅢC/Ⅳ) NSCLC admitted to Xinjiang Production and Construction Corps Hospital (The Second Affiliated Hospital, School of Medicine, Shihezi University) from January 2019 to June 2023 were retrospectively selected as the subjects, including 33 patients in the observation group and 31 patients in the control group. Bevacizumab injection was administered intravenously or anrotinib hydrochloride capsules were administered orally. The proportion of peripheral plasma CD3⁺ T cells, CD4⁺ T cells, CD8⁺ T cells, CD4⁺ /CD8⁺ T cells, CD4⁺ /CD25⁺ regulatory T cells before and 6 weeks after treatment were analyzed by flow cytometry. The primary endpoint is to evaluate treatment response and survival based on the clinical efficacy evaluation criteria for solid tumors version 1.1, and calculate disease control rate and objective efficacy rate; Statistics on progression free survival and overall survival. The secondary endpoints are the occurrence and severity of adverse events, as well as abnormal changes in vital signs and laboratory parameters, according to the National Cancer Institute′s Common Terminology for Adverse Events 4.0. The follow-up deadline is December 2024.

There was no statistically significant difference in objective efficacy between the control group and the observation group (25.81% vs. 42.42%, P=0.162). However, the disease control rate of the control group patients was significantly lower than that of the observation group (61.29% vs. 90.91%, P=0.007). After treatment, the proportions of CD4⁺ and CD4⁺ /CD8⁺ in both groups increased compared to before treatment, and the observation group was higher than the control group (CD4⁺ : 40.48±9.86% vs. 34.03±7.48%, P=0.005; CD4⁺ /CD8⁺ : 1.68±0.59% vs. 1.33±0.49%, P=0.013). In addition, the proportions of CD8⁺ cells (25.92±6.45% vs. 33.62±9.55%) and CD4⁺ CD25⁺ (4.47±1.80% vs. 5.53±2.13%) in the observation group decreased compared to before treatment, while the percentage of CD3⁺ cells (71.66±9.90% vs. 66.18±11.25%) increased compared to before treatment (P<0.05). The incidence of adverse immune reactions was 56.25%, and more than 10% of adverse immune reactions include thyroid dysfunction, blood/lung/gastrointestinal/liver toxicity. Kaplan-Meier survival curve analysis showed that the median progression free survival in the observation group was 7.8 months, which was longer than the control group′s 6.9 months (Log Rank χ²=5.943, P=0.015).

The combination therapy of PD-1 monoclonal antibody and anti angiogenic drugs can improve the immune suppression status of the body, effectively improve the disease control rate and prolong the progression free survival of advanced NSCLC patients, and will not increase immune related adverse reactions during the treatment process.