AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026020015
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ORIGINAL RESEARCH ARTICLE

Efficacy and safety of the combination of PEG–rhG-CSF with camrelizumab and chemotherapy in advanced squamous nonsmall cell lung cancer: A randomized controlled trial

Tong Zhao1 ,  Tingting Zhu1 ,  Lei Chen1 ,  Weike Zhang1*
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1 Department of Oncology, The Eighth People’s Hospital of Jinan City, Jinan, Shandong, China
EJMO, 026020015 https://doi.org/10.36922/EJMO026020015
Received: 9 January 2026 | Revised: 15 April 2026 | Accepted: 22 April 2026 | Published online: 19 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Optimizing first-line chemoimmunotherapy for advanced squamous non–small cell lung cancer (sqNSCLC) remains challenging, particularly in balancing efficacy with treatment-related hematologic toxicity.

Objective: This study aims to evaluate whether adding polyethylene glycol–recombinant human granulocyte colony-stimulating factor (PEG–rhG-CSF) to first-line camrelizumab and platinum-based chemotherapy improves outcomes in patients with advanced sqNSCLC.

Methods: In this single-center, randomized controlled trial, 212 patients with treatment–naïve stage IV sqNSCLC were enrolled between 2020 and 2021. Among them, 23 were lost to follow-up, leaving 189 patients included in the study. They were randomly assigned (1:1) to receive either camrelizumab, paclitaxel, and carboplatin (control group, n = 94) or the same regimen plus prophylactic PEG–rhG-CSF (experimental group, n = 95). The primary endpoint was progression-free survival (PFS), and the secondary endpoints were objective response rate (ORR), overall survival (OS), and safety.

Results: Among the evaluable patients, the ORR was significantly higher in the experimental group (58.95% vs. 43.62%; p = 0.0355). The disease control rate was comparable between groups (85.26% vs. 76.60%; p = 0.2431). The experimental group demonstrated significantly longer median PFS (10.5 vs. 8.4 months; hazard ratio [HR] = 0.72, 95% confidence interval [CI] 0.52–0.99; p = 0.0423) and a strong trend toward improved median OS (not reached vs. 22.3 months; HR = 0.67, 95% CI 0.45–0.99; p = 0.0432). Survival benefit was consistent across all predefined subgroups. The incidence of neutropenia was significantly lower in the experimental group (p < 0.0001), while fever was more common (p = 0.0256). Other adverse events were similar between groups.

Conclusion: The addition of PEG–rhG-CSF to first-line camrelizumab-based chemoimmunotherapy in advanced sqNSCLC significantly improved tumor response and PFS, showed a promising OS benefit, reduced chemotherapy–induced neutropenia, and maintained a manageable safety profile. These findings suggest a potential synergistic role for PEG–rhG–CSF beyond supportive care in this setting.

Keywords
Polyethylene glycol–recombinant human granulocyte colony–stimulating factor
Camrelizumab
Advanced squamous non–small cell lung cancer
Immunotherapy
Chemotherapy
Funding
This study received financial support from the Research Project on Supporting Treatment for Emerging Tumors in China, specifically under the project titled “Randomized Controlled Trial Evaluating the Efficacy and Safety of Polyethylene Glycolated Recombinant Human Granulocyte-Stimulating Factor or Placebo Combined with Camrelizumab, Paclitaxel, and Platinum-Based Chemotherapy as First-Line Treatment for Advanced Squamous Cell Lung Cancer” (cphcf-2022-011).
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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