Camrelizumab Combined with Apatinib and Albumin Paclitaxel in Advanced Nonsquamous NSCLC: CAPAP-Lung Phase 2 Study

Accumulating evidence has demonstrated that the addition of cytotoxic chemotherapy and antiangiogenic therapy to immune checkpoint inhibitors (ICIs) may result in improved clinical benefit.¹ Platinum-containing dual-agent chemotherapy combined with ICIs is the standard first-line treatment for patients with non–small-cell lung cancer (NSCLC); however, the optimal combination regimen remains unclear.² In addition, platinum-based chemotherapy is associated with a serious adverse events profile.²

The CAPAP-lung study was a single-arm, multicenter, phase 2 trial that aimed to evaluate the efficacy and safety of camrelizumab (a PD-1 inhibitor) in combination with apatinib (a vascular endothelial growth factor receptor-2 inhibitor), and albumin paclitaxel without platinum as first-line therapy for nonsquamous NSCLC.²

Patients diagnosed with EGFR- and ALK-negative advanced nonsquamous NSCLC were treated with camrelizumab (200 mg every 3 weeks) in combination with 4 to 6 cycles of albumin paclitaxel (135 mg/m², day 1, day 8/every 3 weeks) and apatinib (250 mg once daily for 5 days, resting for 2 days every week).²

A total of 54 patients of the planned 63 were enrolled from August 2020 to February 2022. The primary end point was progression-free survival (PFS), and secondary end points were overall survival, duration of response, objective response rate (ORR), and disease control rate (DCR) assessed by RECIST version 1.1.²

Of 54 enrolled patients, 38 were eligible for evaluation. Median PFS was 10.97 months (95% confidence interval [CI], 7.1-not reached) and the ORR and DCR were 71.1% (27/38; 95% CI, 53.9-84.0) and 97.4% (37/38; 95% CI, 84.6-99.9), respectively. Grade 3 adverse events were observed in 25 (46.3%) patients and grade 4 events were seen in 3 (5.6%) patients. The most common grade 3 treatment-related adverse events were decreased neutrophil count (14.8%), liver function damage (16.7%), rash (5.6%), and decreased white blood cell count (5.6%).

In summary, camrelizumab combined with albumin paclitaxel and apatinib demonstrated promising anticancer activity with a manageable safety profile for the first-line treatment of advanced nonsquamous NSCLC.

References

1. Song Y, Fu Y, Xie Q, et al. Anti-angiogenic agents in combination with immune checkpoint inhibitors: a promising strategy for cancer treatment. Front Immunol. 2020;11:1956.
2. Wu L, Pu X, Lin G, et al. Platinum-free chemotherapy in the new era of immunotherapy: a phase II study of camrelizumab combined with apatinib and albumin paclitaxel in advanced non-squamous NSCLC (CAPAP-lung). Presented at: 2022 American Society of Clinical Oncology Annual Meeting; June 3-7, 2021; Chicago, IL. Abstract 9034.