ArticleFrontiers in oncology2026
The efficacy and safety of four different PD-1 checkpoint inhibitors in advanced non-small cell lung cancer: a real-world retrospective study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While various PD-1 inhibitors are approved for advanced non-small cell lung cancer (NSCLC), direct comparisons of their real-world efficacy and safety are limited. This retrospective study evaluates four PD-1 inhibitors (pembrolizumab, sintilimab, tislelizumab, and camrelizumab) in real-world clinical practice to supplement registered clinical trial (RCT) data. Methods: We retrospectively screened 563 patients with stage IIIB-IV NSCLC who received pembrolizumab, sintilimab, tislelizumab, or camrelizumab (as monotherapy or combined with chemotherapy) between February 1, 2019, and December 31, 2022. The follow-up cutoff date was September 15, 2023. Results: A total of 409 eligible patients were included (pembrolizumab: 136; sintilimab: 115; tislelizumab: 123; camrelizumab: 35). For squamous NSCLC, no significant differences in effectiveness were observed among the four inhibitors, regardless of the treatment line. For nonsquamous NSCLC, second or later-line camrelizumab was associated with a higher risk of disease progression (progression-free survival [PFS] hazard ratio [HR] 2.29; 95% CI 1.01-5.19) and mortality (overall survival [OS] HR 3.14; 95% CI 1.28-7.74) compared to pembrolizumab, despite similar objective response rates. Regarding safety, immune-related adverse events (irAEs) were consistent and manageable. Notably, sintilimab demonstrated a significantly lower incidence of irAEs than the other three inhibitors across any grade ( Conclusions: In this real-world, single-center retrospective study, sintilimab and tislelizumab showed efficacy estimates broadly similar to pembrolizumab in advanced NSCLC within prespecified strata. Camrelizumab was associated with shorter PFS/OS in previously treated nonsquamous NSCLC; however, this finding is hypothesis-generating given small subgroup sizes, treatment heterogeneity, and potential residual confounding. Overall irAEs were manageable; differences in recorded incidence should be interpreted cautiously.
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