Camrelizumab Associated With Higher Progression Risk Versus Pembrolizumab in Nonsquamous NSCLC Cohort

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Frontiers in Medicine Published April 28, 2026 Medically reviewed April 28, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Interpret survival differences cautiously as findings are hypothesis-generating from retrospective cohort study.

This retrospective cohort study analyzed 409 eligible patients with stage IIIB-IV non-small cell lung cancer in a single-center real-world setting. Interventions included pembrolizumab, sintilimab, tislelizumab, or camrelizumab as monotherapy or combined with chemotherapy. The cutoff date for follow-up was September 15, 2023.

In second or later-line nonsquamous non-small cell lung cancer, camrelizumab was associated with a higher risk of disease progression compared to pembrolizumab (HR 2.29, 95% CI 1.01-5.19). Overall survival also showed a higher risk of mortality with camrelizumab versus pembrolizumab (HR 3.14, 95% CI 1.28-7.74). Objective response rates were similar between these agents.

Sintilimab demonstrated a significantly lower incidence of immune-related adverse events compared to the other three inhibitors (P = 0.004 for any grade; P = 0.005 for grades 3-5). No significant differences in effectiveness were observed among the four inhibitors in squamous non-small cell lung cancer.

Key limitations include small subgroup sizes, treatment heterogeneity, potential residual confounding, and single-center design. The authors note findings are hypothesis-generating and differences in recorded incidence should be interpreted cautiously. This evidence supplements registered clinical trial data for real-world efficacy and safety comparisons.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

BackgroundWhile various PD-1 inhibitors are approved for advanced non-small cell lung cancer (NSCLC), direct comparisons of their real-world efficacy and safety are limited. This retrospective study evaluates four PD-1 inhibitors (pembrolizumab, sintilimab, tislelizumab, and camrelizumab) in real-world clinical practice to supplement registered clinical trial (RCT) data.MethodsWe retrospectively screened 563 patients with stage IIIB-IV NSCLC who received pembrolizumab, sintilimab, tislelizumab, or camrelizumab (as monotherapy or combined with chemotherapy) between February 1, 2019, and December 31, 2022. The follow-up cutoff date was September 15, 2023.ResultsA total of 409 eligible patients were included (pembrolizumab: 136; sintilimab: 115; tislelizumab: 123; camrelizumab: 35). For squamous NSCLC, no significant differences in effectiveness were observed among the four inhibitors, regardless of the treatment line. For nonsquamous NSCLC, second or later-line camrelizumab was associated with a higher risk of disease progression (progression-free survival [PFS] hazard ratio [HR] 2.29; 95% CI 1.01-5.19) and mortality (overall survival [OS] HR 3.14; 95% CI 1.28-7.74) compared to pembrolizumab, despite similar objective response rates. Regarding safety, immune-related adverse events (irAEs) were consistent and manageable. Notably, sintilimab demonstrated a significantly lower incidence of irAEs than the other three inhibitors across any grade (P = 0.004) and grades 3-5 (P = 0.005).ConclusionsIn this real-world, single-center retrospective study, sintilimab and tislelizumab showed efficacy estimates broadly similar to pembrolizumab in advanced NSCLC within prespecified strata. Camrelizumab was associated with shorter PFS/OS in previously treated nonsquamous NSCLC; however, this finding is hypothesis-generating given small subgroup sizes, treatment heterogeneity, and potential residual confounding. Overall irAEs were manageable; differences in recorded incidence should be interpreted cautiously.