Abstract:

Objective To explore the impact of pembrolizumab combined with chemotherapy on angiogenesis and circulating endothelial cells in patients with advanced non-small cell lung cancer （NSCLC）. Methods The retrospective analysis of clinical data from 121 patients diagnosed with advanced NSCLC who were admitted to the Second Affiliated Hospital of Xingtai Medical College from August 2021 to January 2023 was conducted. These patients were divided into a control group （n=57）and an observation group （n=64）based on the designated treatment protocol. Specifically，individuals in the control group received standard chemotherapy（cisplatin+paclitaxel），while those in the observation group underwent penpilimab therapy in conjunction with conventional chemotherapy. The comparative assessment encompassed short-term clinical efficacy，quality of life，immune function parameters，angiogenic factors [including endostatin，insulin-like growth factor 1 （IGF-1），and vascular endothelial growth factor （VEGF）]，circulating endothelial cells，and adverse reactions within the two groups. Results After 6 courses of treatment，the objective response rate [67.19% （43/64）vs. 49.12% （28/57）] and disease control rate [87.50% （56/64）vs. 70.18% （40/57）] in observation group were higher than those in control group，with statistically significant differences （χ²=4.06，P=0.044； χ²=5.52，P=0.019）. The quality of life score of observation group [（56.77±6.81）points] was significantly higher than that of control group [（47.73±8.23）points]，with a statistically significant difference （t=6.61，P<0.001）； The T cell subgroup CD3⁺ levels [（63.59±9.00）% vs. （53.06±8.80%），t=6.49，P<0.001]，CD4⁺ levels [（46.54±8.20）% vs. （30.74±7.32）%，t=11.13，P<0.001] and CD4⁺/CD8⁺ ratio （1.90±0.36 vs. 1.21±0.28，t=11.66，P<0.001）in observation group were significantly higher than those in control group，with statistically significant differences； Endostatin in observation group [（48.99±3.43）μmol/L] was significantly higher than that in control group [（31.35±3.87）μmol/L]，with a statistically significant difference （t=26.58，P<0.001），IGF-1 [（102.31±20.35）μg/L vs. （134.98±19.02）μg/L] and VEGF [（31.70±4.32）pg/ml vs. （58.71±5.99）pg/ml] were significantly lower in observation group than those in control group，with statistically significant differences （t=18.73，P<0.001； t=28.14，P<0.001）. The number of circulating endothelial cells in observation group [（58.77±10.03）/ml] was significantly lower than that in control group [（87.01±8.01）/ml]，with a statistically significant difference （t=17.20，P<0.001）. During treatment，there were no statistically significant differences in the incidence of gastrointestinal reaction （χ²=0.01，P=0.908），leukopenia （χ²=0.64，P=0.424），thrombocytopenia （χ²=0.28，P=0.597），anemia （χ²=1.66，P=0.197），nephrotoxicity （χ²=0.64，P=0.424），skin rash （χ²=1.33，P=0.249）between the two groups. Conclusion The combination therapy of pembrolizumab and chemotherapy for the treatment of advanced NSCLC has demonstrated noteworthy effectiveness. This regimen has the potential to enhance patients' immune functionality，ameliorate their overall quality of life，suppress angiogenesis，and exhibits a commendable profile of safety and reliability.

Key words: Carcinoma, non-small-cell lung, Antineoplastic combined chemotherapy protocols, Vascular endothelial growth factors, Circulating endothelial cells, Treatment outcome