ArticleFrontiers in oncology2026
Efficacy and safety of chemotherapy plus immunotherapy in unresectable stage III-IV non-small cell lung cancer, with analysis of the additional role of anti-angiogenic agents.
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
Purpose: Chemo-immunotherapy has demonstrated significant survival benefits in non-small cell lung cancer. However, real-world data on its effectiveness and safety in patients with unresectable stage III-IV disease remain insufficient. Furthermore, whether the addition of anti-angiogenic agents provides additional benefit beyond chemo-immunotherapy remains unclear. This study aimed to evaluate the real-world effectiveness and safety of adding immune checkpoint inhibitors to chemotherapy, and to further explore the added value of anti-angiogenic therapy. Methods: A total of 260 patients with unresectable stage III/IV NSCLC treated at two centers (2018-2025) were enrolled. Patients were divided into a chemotherapy-based immunotherapy group (n=162) and a non-immunotherapy chemotherapy group (n=98); the former was further stratified by the addition of anti-angiogenic therapy (n=71) or not (n=91). To address baseline imbalances between groups, propensity score matching (PSM) (1:1 nearest-neighbor, caliper=0.2 SD) was performed using key covariates. Progression-free survival and overall survival were assessed using Kaplan-Meier analysis and Cox regression. Adverse events were graded per CTCAE 5.0. Results: Chemotherapy-based immunotherapy significantly prolonged median PFS (9.0 vs 6.8 months, P<0.001) and OS (22 vs 14.2 months, P = 0.028) compared with non-immunotherapy chemotherapy regimens. This regimen was independently associated with improved PFS (HR = 0.56, P<0.001) and OS (HR = 0.65, P = 0.018). Conversely, ECOG PS 2 was a strong independent predictor of worse prognosis (PFS: HR = 6.45; OS: HR = 5.50, both P<0.001). Among recipients of chemotherapy‑based immunotherapy, adding anti-angiogenic therapy further improved PFS (9.1 vs 6.8 months, P = 0.044; HR = 0.69, P = 0.060), with no significant increase in adverse events (P > 0.05). Conclusions: Chemoimmunotherapy significantly improved PFS and OS in unresectable stage III/IV NSCLC. The addition of anti-angiogenic agents to this backbone further prolonged PFS without increasing adverse events.
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