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Updated: Jun 20, 2026
Orthotopic Transplantation of Syngeneic Lung Adenocarcinoma Cells to Study PD-L1 Expression
Published on: January 19, 2019
Clinical exploration of first-line therapy in metastatic lung adenocarcinoma patients with negative or low PD-L1
Kun Xu1, Ruoxue Cai2, Zijian Sun1
1Department of Oncology, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Nanjing, China.
Background:
Either Programmed cell death protein 1 (PD-1)/Programmed cell death-Ligand protein 1 (PD-L1) inhibitors plus chemotherapy or anti-angiogenic agents plus chemotherapy has become first-line therapy in negative or low PD-L1 patients with driver-gene-negative metastatic lung adenocarcinoma. PD-1/PD-L1 inhibitors plus anti-angiogenic agents with chemotherapy is also an option. However, there are no large studies evaluating the advantages and disadvantages of the three treatment strategies.
Methods:
Totally 163 stage IV lung adenocarcinoma patients with negative or low PD-L1 expression who received first-line treatment at Nanjing Medical University Affiliated Cancer Hospital from November 1, 2019 to December 1, 2023 were analyzed. We evaluated the difference in efficacy of multiple treatment regimens.
Results:
57 patients received anti-angiogenic agents plus chemotherapy (AC group), 69 patients received PD-1/PD-L1 inhibitors plus chemotherapy (PC group) and 37 patients received PD-1/PD-L1 inhibitors plus anti-angiogenic agents with chemotherapy (APC group). The median progression-free survival (mPFS) was 6.3 months, 8.7 months and 13.8 months in AC, PC and APC group, respectively. The APC group significantly prolonged patients' PFS compared to the AC and PC groups. APC group and PC group had no significant difference in overall survival (OS) compared to AC group. Subgroup analysis showed that APC group significantly lowered the risk of disease progression compared to AC group in the PD-L1-negative subgroup. The incidence of grade 3-4 adverse events (AEs) was similar in three groups.
Conclusions:
Among the first-line treatment regimens for metastatic lung adenocarcinoma patients with negative or low PD-L1 expression, PD-1/PD-L1 inhibitors plus anti-angiogenic agents with chemotherapy showed significant benefit in PFS compared to anti-angiogenic agents plus chemotherapy and PD-1/PD-L1 inhibitors plus chemotherapy.
Insights
The combination of PD-1/PD-L1 inhibitors and anti-angiogenic agents with chemotherapy offers improved progression-free survival for metastatic lung adenocarcinoma patients with low PD-L1 expression compared to other first-line treatments.
Area of Science:
- Oncology
- Immunotherapy
- Pharmacology
Background:
- First-line therapy for metastatic lung adenocarcinoma with negative or low PD-L1 expression includes PD-1/PD-L1 inhibitors plus chemotherapy or anti-angiogenic agents plus chemotherapy.
- Combination therapy with PD-1/PD-L1 inhibitors and anti-angiogenic agents plus chemotherapy is also an option.
- Limited large-scale studies compare these three first-line treatment strategies.
Purpose of the Study:
- To evaluate and compare the efficacy of three distinct first-line treatment regimens.
- To assess the impact of PD-1/PD-L1 inhibitors, anti-angiogenic agents, and chemotherapy combinations on patient outcomes.
- To identify the optimal first-line treatment strategy for metastatic lung adenocarcinoma with negative or low PD-L1 expression.
Main Methods:
- Retrospective analysis of 163 stage IV lung adenocarcinoma patients with negative or low PD-L1 expression.
- Patients received first-line treatment between November 2019 and December 2023.
- Comparison of efficacy between anti-angiogenic plus chemotherapy (AC), PD-1/PD-L1 inhibitor plus chemotherapy (PC), and PD-1/PD-L1 inhibitor plus anti-angiogenic plus chemotherapy (APC) groups.
Main Results:
- Median progression-free survival (mPFS) was 6.3 months (AC), 8.7 months (PC), and 13.8 months (APC).
- The APC group demonstrated significantly prolonged PFS compared to AC and PC groups.
- No significant difference in overall survival (OS) was observed between APC, PC, and AC groups. Grade 3-4 adverse events were similar across all groups.
Conclusions:
- First-line PD-1/PD-L1 inhibitors plus anti-angiogenic agents with chemotherapy (APC) significantly improves PFS in metastatic lung adenocarcinoma patients with negative or low PD-L1 expression.
- The APC regimen shows superior efficacy compared to AC and PC regimens in terms of progression-free survival.
- APC therapy represents a promising first-line treatment option, particularly for PD-L1 negative subgroups, without increasing severe adverse events.
