Remarkable efficacy of ivonescimab-based second-line therapy in advanced lung adenocarcinoma resistant to chemoimmunotherapy: a case report

PD-1/PD-L1 inhibitors combined with chemotherapy are the current standard first-line treatment for advanced lung adenocarcinoma (LUAD). However, chemotherapy typically becomes the main therapeutic approach for subsequent treatment once the development of resistance to this initial chemoimmunotherapy, and there are limited effective treatment options available. This case report describes a 41-year-old male patient with stage IVA LUAD (PD-L1 tumor proportion score: 5%, next-generation sequencing: no mutation) who achieved a partial response (PR) with first-line camrelizumab plus pemetrexed and carboplatin, but later experienced disease progression. Upon switching to second-line therapy with ivonescimab (an anti-PD-1/vascular endothelial growth factor-A bispecific antibody) combined with docetaxel, the patient achieved a significant clinical and radiographic response, again evaluated as PR, which was sustained over 12 treatment cycles. Up to now, the progression-free survival (PFS) is more than 12 months, which is significantly longer than the 9-month PFS achieved by the first-line treatment. The regimen was well-tolerated, with only grade 1 adverse events. This case highlights the potential of ivonescimab-based therapy as an effective and manageable second-line option for patients with advanced LUAD who have progressed on prior immune checkpoint inhibitor therapy, even with low PD-L1 expression.