Nivolumab in combination with anlotinib achieved remarkable efficacy in a patient with driver-negative lung squamous cell carcinoma and PS of 4.

Patients with driver-negative non-small cell lung cancer (NSCLC) and performance status (PS) of 3-4 do not tolerate chemotherapy well. There is currently no suitable treatment plan, and best supportive care is offered to patients with PS of 3 or greater. Some retrospective studies have shown the poor efficacy of immune checkpoint inhibitors (ICIs) for advanced NSCLC patients with PS ≥2 regardless of PD-L1 expression. However, some recent studies suggest that the anti-angiogenic drug has an immunomodulatory effect and can enhance immune efficacy. Here, we report a 72-year-old male patient with a diagnosis of driver-negative lung squamous cell carcinoma with respiratory failure and other serious medical conditions, resulting in PS of 4. We tried administering nivolumab (immune checkpoint inhibitor, ICI) in combination with anlotinib (angiogenic inhibitor) treatment to the patient. After 2 months of combination treatment, improved PS and a partial response (PR) was observed. Presently, the patient is on regular follow-up for over 13 months without any evidence of disease progression or distant metastasis. Our successful treatment of this driver-negative lung squamous cell carcinoma patient provides optimistic data to support the synergistic effect of immunotherapy and anti-angiogenesis therapy, and also demonstrated the potential application of this treatment regimen in critically ill patients.