β-glucan combined with Envafolimab and Endostar as immune rechallenge for metastatic non-small cell lung cancer

Qian Geng1,2, Yingying Lu2, Dongqing Li1,2

  • 1Changzhou Medical Center, Nanjing Medical University, Changzhou, 213003, China.

BMC Immunology
|September 13, 2024
PubMed
Abstract

Insights

This study shows that combining β-glucan with Envafolimab and Endostar is effective for non-small cell lung cancer (NSCLC) patients who previously failed anti-PD-1 therapy. The treatment demonstrated considerable efficacy and safety, particularly in PD-L1 positive patients.

Area of Science:

  • Oncology
  • Immunotherapy
  • Pharmacology

Background:

  • Immune checkpoint inhibitor (ICI) rechallenge is a key strategy for non-small cell lung cancer (NSCLC).
  • β-glucan has shown potential in overcoming resistance to anti-PD-1/PD-L1 therapies by modulating the tumor microenvironment.
  • Previous anti-PD-1 therapy failure necessitates novel treatment approaches for advanced NSCLC.

Purpose of the Study:

  • To evaluate the clinical efficacy and safety of a combination therapy involving β-glucan, Envafolimab, and Endostar.
  • To assess the impact of this regimen as an immune rechallenge strategy in metastatic NSCLC patients.
  • To explore potential proteomic biomarkers associated with treatment response and resistance.

Main Methods:

  • A self-initiated clinical trial (ChiCTR2100054796) enrolled 23 NSCLC patients previously treated with anti-PD-1 therapy.
  • Patients received a combination of β-glucan, Envafolimab, and Endostar every three weeks until disease progression or toxicity.
  • Serum samples were collected for proteomic analysis to identify response-related proteins.

Main Results:

  • The overall response rate (ORR) was 21.7% and the disease control rate (DCR) was 73.9%.
  • Median progression-free survival (mPFS) was 4.3 months and median overall survival (mOS) was 9.8 months.
  • A significant difference in mPFS was observed between PD-L1 positive (6.3 months) and negative (2.3 months) subgroups (p=0.002).
  • Common treatment-related adverse events included hypothyroidism and fatigue; no treatment-related deaths occurred.

Conclusions:

  • The combination of β-glucan, Envafolimab, and Endostar demonstrates considerable efficacy and safety for immune rechallenge in metastatic NSCLC patients.
  • This regimen is particularly beneficial for patients with PD-L1 positive tumors who have previously failed anti-PD-1 treatment.
  • Proteomic analysis identified potential biomarkers (e.g., CASP-8, ARG1, CD40-L, EGF) correlating with treatment outcomes.

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