Efficacy and Safety of PD-1/L1 Inhibitors Combined with Anlotinib versus PD-1 /L1 Inhibitors Combined with Bevacizumab in Second-Line Treatment of Advanced Non-Small Cell Lung Cancer Patients: A Comparative Cohort Study

Background: This study aimed to compare the efficacy and safety of PD-1/L1 in-hibitors combined with anlotinib versus PD-1/L1 inhibitors combined with bevacizumab as second-line treatments for advanced NSCLC patients. Methods: A retrospective analysis was carried out on data from advanced NSCLC patients who received either PD-1/L1 inhibitors combined with anlotinib or PD-1/L1 inhibitors com-bined with bevacizumab as second-line therapy. Clinical outcomes, including Overall Sur-vival (OS), Progression-Free Survival (PFS), Objective Response Rate (ORR), Disease Con-trol Rate (DCR), and Adverse Events (AEs), were compared between the two treatment groups. Results: The results revealed that patients receiving PD-1/L1 inhibitors combined with anlo-tinib exhibited better efficacy compared to patients receiving PD-1/L1 inhibitors combined with bevacizumab (mPFS 5.0m vs. 4.0m, mOS 10.0m vs. 8.0m, ORR 31.25% vs. 17.14%, DCR 65.63% vs. 45.71%). Additionally, both treatment regimens were generally well-tolerated, with most adverse events being manageable and of mild to moderate severity. However, compared with patients receiving PD-1/L1 inhibitors combined with bevaci-zumab, those receiving PD-1/L1 inhibitors combined with anlotinib have higher incidence rates of certain adverse reactions (hypertension: 34.38% vs. 17.14%, proteinuria: 25% vs. 14.29%), implying that drug combinations of the same treatment modality may exhibit dif-ferences in efficacy and adverse reactions. Conclusion: In this comparative study, PD-1/L1 inhibitors combined with anlotinib demon-strated superior efficacy compared to PD-1/L1 inhibitors combined with bevacizumab as second-line therapy for advanced NSCLC patients, with a manageable safety profile. These findings provide valuable clinical evidence for guiding treatment decisions in this patient population.