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ARTICLE

Factors Affecting the Efficacy and Safety of First-Line Anti-PD-1 Therapy in Advanced Non-Small Cell Lung Cancer

Zhen Wang1, Qian Xie2, Yu Luo3, Chuan Li1, Wenqiang Guan1, Yanling Zhang4, Jidong Miao1,*
1 Department of Oncology, Zigong Fourth People’s Hospital, Ziliujing District, Zigong, China
2 School of Education and Sports, Sichuan Vocational College of Health and Rehabilitation, Yantian District, Zigong, China
3 Department of Critical Care, Qingdao Municipal Hospital, Shinan District, Qingdao, China
4 Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao University, Shinan District, Qingdao, China
* Corresponding Author: Jidong Miao. Email: email
(This article belongs to the Special Issue: Advances in Cancer Immunotherapy)

Oncology Research https://doi.org/10.32604/or.2026.079813

Received 29 January 2026; Accepted 16 April 2026; Published online 11 May 2026

Abstract

Objective: This study assesses peripheral blood parameters as predictors of programmed cell death protein-1 (PD-1) inhibitor efficacy in advanced non-small cell lung cancer (NSCLC). Methods: We retrospectively analyzed 169 advanced NSCLC patients receiving first-line PD-1 inhibitor-based therapy. Baseline blood parameters and clinical characteristics were recorded. Logistic regression assessed associations with immune-related adverse events (irAEs). Chi-square tests compared efficacy and safety across treatment groups. Results: Baseline albumin/fibrinogen ratio (ALB/FIB) and PIV were associated with all-grade irAEs (p < 0.05), while PIV was markedly associated with grade ≥3 irAEs (p < 0.01). Multivariate analysis identified that the baseline pan-immune inflammation value (PIV) was independently associated with the occurrence of irAEs (p < 0.01). Compared to PD-1 inhibitor plus chemotherapy, adding bevacizumab increased oral mucositis (p = 0.010) and was linked to a later clinical stage (p = 0.001). In patients receiving peri-immunotherapy radiotherapy, leukopenia was more frequent (p = 0.030). Conclusion: Baseline PIV is independently associated with the occurrence of irAEs in advanced NSCLC patients receiving first-line PD-1 inhibitor therapy. Adding bevacizumab or radiotherapy may modify safety profiles.

Keywords

Advanced non-small cell lung cancer; PD-1 inhibitors; safety; immune-related adverse events; prognosis

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