Effectiveness and safety of camrelizumab combined with pemetrexed-carboplatin in advanced nonsquamous non-small cell lung cancer (NSCLC): a systematic review and meta-analysis

Intan Dwikarlina; Genta Antariksa; Brenda Kristi; Muhammad Nayif Alan Hamada

doi:10.22146/inajbcs.v57i3.Supplement.24251

Intan Dwikarlina Medical Doctor, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
Genta Antariksa Medical Doctor, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
Brenda Kristi Medical Doctor, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia
Muhammad Nayif Alan Hamada Medical Doctor, Faculty of Medicine, Brawijaya University, Malang, East Java, Indonesia

DOI: https://doi.org/10.22146/inajbcs.v57i3.Supplement.24251

Keywords: Camrelizumab, Pemetrexed/Carboplatin, Advanced Nonsquamous Non-Small Cell Lung Carcinoma, survival benefits

Abstract

Lung cancer is the second most common malignancy worldwide, with non-small cell lung cancer (NSCLC) comprising about 80% of cases. Platinum-based chemotherapy with third-generation agents such as pemetrexed-carboplatin remains the first-line treatment for nonsquamous advanced NSCLC; however, survival benefits remain limited and immune evasion persists. Camrelizumab (SHR-1210), a humanized anti-PD-1 monoclonal antibody, enhances antitumor immunity by blocking the PD-1/PD-L1 pathway. This systematic review and meta-analysis evaluated the efficacy of camrelizumab combined with chemotherapy in advanced NSCLC, in accordance with PRISMA guidelines. A comprehensive search was performed in PubMed, EBSCO, Cochrane, ScienceDirect, Wiley, and Google Scholar for English-language publications up to July 2025. Study quality was assessed using the Modified Jadad Score, Newcastle–Ottawa Scale, and JBI Checklist. Statistical analyses were conducted with Review Manager 5.4. The main outcomes included overall survival (OS) and progression-free survival (PFS), expressed as hazard ratios (HRs), and objective response rate (ORR) and disease control rate (DCR), expressed as odds ratios (ORs). Six studies were identified; after excluding duplicates, four trials with a total of 332 patients (stage IIIB–IV adenocarcinoma) were analyzed. Camrelizumab-based regimens significantly improved OS (HR = 0.69; 95% CI: 0.55–0.87; p = 0.002) and PFS (HR = 0.42; 95% CI: 0.28–0.63; p < 0.01) compared with non-camrelizumab regimens. Reported ORR ranged from 40.0% to 58.8%, while DCR was 75.6%–87.7%. Most adverse events were mild (grade ≤2) and manageable. Hematologic toxicities included anemia (OR 4.1; p < 0.00001) and thrombocytopenia (OR 2.59; p < 0.0001), whereas common non-hematologic toxicities included skin reactions (OR 101.42; p < 0.00001), fatigue (OR 16.39; p < 0.00001), and nausea/vomiting (OR 23.56; p < 0.00001). Camrelizumab increases CD8+ T-cell infiltration. In combination with carboplatin and pemetrexed, it shows promising efficacy with a tolerable safety profile in advanced nonsquamous NSCLC. Large-scale trials remain necessary to validate long-term outcomes.