Discussion
tumor, toxicity, proteinuria, PTCL, hyperthyroidism, infection, tumors, ENKTL
VIRUS, INFILTRATION, TUMOR, HYPERTENSION, HYPERLIPIDEMIA, HYPOXIC, INFECTION, HYPERTHYROIDISM, TUMOR GROWTH, TUMORS, PATHOGENESIS
To our knowledge, this is the first study to report the efficacy and safety profile of a PD-1 inhibitor combined with an antiangiogenic drug for r/r PTCL. In this study, the combination of camrelizumab and apatinib-treated r/r PTCL obtained an ORR of 30% and a CR rate of 10%. The median PFS and OS were 5.6 months and 16.7 months, respectively. The toxicity was tolerable, and no new safety signals were detected.The prognosis of r/r PTCL is poor. Several studies have reported the outcomes of r/r PTCL at a population level, showing a median OS of less than 6 months (It is generally believed that the pathogenesis of ENKTL is closely related to Epstein−Barr virus (EBV) infection. EBV can drive LMP1 to upregulate PD-L1 expression on T lymphocytes (During tumor growth, abnormal vasculature formation occurs, which creates a hypoxic microenvironment that promotes the differentiation of immunosuppressive cells from inflammatory cells, hindering the infiltration of T cells and other immune cells into the tumor microenvironment (Preclinical studies have shown that low-dose apatinib may upregulate PD-1 expression on tumor-infiltrating immune cells more effectively than full-dose apatinib, increase immune effector cell infiltration into tumors, and enhance the antitumor activity of PD-1 inhibitors (The combination of low-dose apatinib and camrelizumab did not result in unexpected toxicity. Except for 2 patients who discontinued treatment due to AEs, the remaining patients tolerated treatment well. Hyperlipidemia, hypertension, proteinuria, and hematologic toxicity observed in this trial were considered apatinib-related, while hyperthyroidism was considered camrelizumab-related. Other AEs were probably due to the combination therapy. The incidence of AEs of the combination therapy was no higher than that of monotherapy (There are several limitations. First, this study consisted of a relatively small sample size. Second, it was a single arm without a control group. Further study is needed to confirm our findings.Camrelizumab plus apatinib had preliminary clinical activity and manageable toxicity in patients with r/r PTCL. Further investigations are necessary to examine the potential of this combination regimen in treating patients with PTCL.