PD-1 Combined With Bevacizumab and PCSK-9 Inhibitor in Patients With Advanced NSCLC Who Have Progressed After Anti- PD- 1/L1 Therapy

1\. Pathological diagnosis of small cell lung cancer (SCLC), including lung cancer mixed with SCLC and NSCLC

2\. The patient has received first-line or more PD - (L) 1 inhibitor monotherapy or combination chemotherapy treatment

3\. Received the following treatments:

1. Received systemic anti-tumor therapy within 3 weeks prior to treatment, such as chemotherapy, targeted therapy, immunotherapy (including herbal therapy with anti-tumor indications), etc

2. Received any investigational drug treatment within 4 weeks prior to treatment

3. Received high doses of immunosuppressive drugs (systemic corticosteroids exceeding 10mg/day, prednisone or its equivalent) within 4 weeks prior to treatment

4. Received attenuated live vaccine within 4 weeks prior to treatment (or planned to receive attenuated live vaccine during the study period)

5. Has undergone major surgery (such as open cavity, thoracotomy, or Kaifu surgery) within 4 weeks before treatment, or has unhealed surgical wounds, ulcers, or fractures

4\. There is clinically uncontrollable pleural/peritoneal effusion (subjects who do not require drainage or have no significant increase in effusion after stopping drainage for 3 days can be enrolled)

5\. Subjects who have received chest radiation therapy greater than 30 Gy within the 6 months prior to treatment or palliative radiation therapy with a dose of 30 Gy or less within the 7 days prior to treatment (palliative radiation therapy for bone lesions or intracranial lesions is allowed)

6\. Within 2 years prior to the first administration, there has been an active autoimmune disease requiring systemic treatment (such as the use of disease relieving drugs, corticosteroids, or immunosuppressants). Alternative therapies (such as thyroid hormone, insulin, or physiological glucocorticoids used for adrenal or pituitary insufficiency) are not considered systemic treatments

7\. Known allogeneic organ transplantation (excluding corneal transplantation) or allogeneic hematopoietic stem cell transplantation

8\. Individuals known to be allergic to the active ingredients or excipients of the study drug

9\. Before starting treatment, if there has been no sufficient recovery from toxicity and/or complications caused by any intervention measures (i.e. ≤ grade 1 or baseline, excluding fatigue or hair loss)

10\. Known history of human immunodeficiency virus (HIV) infection (i.e. HIV 1/2 antibody positive)

11\. Untreated active hepatitis B (defined as HBsAg positive and HBV-DNA copy number detected is greater than the upper limit of normal value in the laboratory of the research center) Note: Those who meet the following criteria can also be included in the group:

1. Before the first administration, the HBV viral load was less than 1000 copies/ml (200 IU/ml), and subjects should receive anti HBV treatment throughout the entire study drug treatment period to avoid viral reactivation

2. For subjects with anti HBc (+), HBsAg (-), anti HBs (-), and HBV viral load (-), prophylactic anti HBV treatment is not necessary, but close monitoring of viral reactivation is necessary

12\. Active HCV infected subjects (HCV antibody positive and HCV-RNA level above the detection limit)

13\. Administer a live vaccine within 30 days prior to the first dose (Day 1 of the first cycle) Note: It is allowed to receive inactivated vaccine for seasonal influenza within 30 days before the first administration; But it is not allowed to receive attenuated live influenza vaccine for intranasal use

14\. Pregnant or lactating women

15\. There are any serious or uncontrollable systemic diseases, such as:

1. Resting electrocardiogram shows significant and difficult to control abnormalities in rhythm, conduction, or morphology, such as complete left bundle branch block, grade II or higher heart block, ventricular arrhythmia, or atrial fibrillation

2. Unstable angina pectoris, congestive heart failure, chronic heart failure classified as NYHA ≥ 2

3. Myocardial infarction occurred within 6 months prior to enrollment

4. Poor blood pressure control (systolic blood pressure\>140 mmHg, diastolic blood pressure\>90 mmHg)

5. A history of non infectious pneumonia requiring corticosteroid treatment within the year prior to the first administration, or current clinical active interstitial lung disease

6. Active pulmonary tuberculosis

7. There are active or uncontrolled infections that require systemic treatment

8. Presence of clinically active diverticulitis, abdominal abscess, and gastrointestinal obstruction

9. Liver diseases such as cirrhosis, decompensated liver disease, acute or chronic active hepatitis

10. Poor control of diabetes (FBG\>10mmol/L)

11. Urine routine shows urinary protein ≥++and confirms 24-hour urinary protein quantification\>1.0 g

12. Subjects with mental disorders who are unable to cooperate with treatment

16\. Medical history or disease evidence that may interfere with the trial results, hinder the full participation of the subjects in the study, abnormal treatment or laboratory test values, or other situations that the researchers believe are not suitable for inclusion. The researchers believe that there are other potential risks that are not suitable for participation in this study

What this study is about