Purpose: Although the presence of Kirsten rat sarcoma virus (KRAS) mutations predicts of a lack of benefit from epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) therapy for none small cell cancer (NSCLC), it may be more sensitive to programmed combination therapy with cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors + anti-angiogenesis. Recent treatment guidelines and clinical studies related to adenocarcinoma in NSCLC have indicated that in patients with inoperable stage IV lung adenocarcinoma, immune checkpoint inhibitors in combination with anti-angiogenic drugs may exert a synergistic effect and significantly improve the efficacy of near-term treatment, but quantification and long-term follow-up of specific clinical indicators are still lacking. No previous cases of long-term good results with camrelizumab combined with anti-angiogenic agents for KRAS-mutated NSCLC have been described. Methods: This manuscript reports a case where patients with advanced NSCLC with pleural effusion and KRAS mutations treated poorly with conventional chemotherapy had long-term (more than 18 months) benefit with immunotherapy combined with an anti-angiogenic inhibitor. In this case, pharmaceutical care of the patient was carried out through therapeutic drug adjustment, compliance, efficacy assessment, and safety evaluation to provide a reference for improving the efficacy and safety of drug therapy in clinical practice. Results: As of the last follow-up date (December 2023), overall survival was 27 months and the patient is currently in good general condition with no significant complaints of discomfort. Conclusion: ICLs in combination with antiangiogenic therapy may be a therapeutic option for patients with KRAS mutations in advanced non-small cell lung cancer with good persistence.

Background: Many patients with mild asthma are undiagnosed and untreated for low diagnostic sensitivity of the bronchodilation test (BDT). Objective: Investigating whether airway reversibility in BDT alone or together with fractional exhaled nitric oxide (FENO) can predict the response to anti-asthma therapy (RAT) in suspected asthma patients. Methods: This study included patients with chronic recurrent asthma symptoms, normal forced expiratory volume in 1 second (FEV1), and negative BDT. Inhaled corticosteroid (ICS) and long-acting β agonist (LABA) were given for 4 weeks. Positive RAT (PRAT) was defined as improved symptoms and increase of FEV1 > 200 mL after ICS/LABA. Lung tissues from 19 patients with lung nodules, grouped by predicted RAT, were also analyzed. Results: Of 102 patients, the PRAT group had higher FENO and greater absolute (∆) and (∆%) percent improvements of forced vital capacity, FEV1, and forced expiratory flows (FEFs) in BDT than the negative RAT group. The AUCs of FENO, ∆FEV1%, ∆FEF25-75%, and ∆FEF75% for PRAT were 0.703, 0.824, 0.736, and 0.710, with the optimal cut-off values of 33 ppb, 3.50%, 15.26%, and 26.04%. A joint model of FENO and ∆FEV1% increased the AUC to 0.880. IL-4, IL-5, IL-13, and NFκB were higher in lung tissues of patients with predicted PRAT than with predicted NRAT. Conclusion: ∆FEV1% > 3.50% in BDT together with FENO > 33 ppb predicted PRAT and an asthma diagnosis in patients with normal FEV1 and negative BDT. Evidence of pathological changes in the early stage of asthma increased the credibility of the predictive model.

Background: Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV1) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky and not readily available in all clinical settings. Methods: A cross-sectional study was performed in 692 patients with FEV1≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness. Results: Compared with subjects negative for BHR (n=522), subjects positive for BHR (n=170) showed increased FENO values, EOS, and R5-R20; decreased FEV1, FEV1/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (P≤.001 for all). Small-airway dysfunction was identified in 104 BHR+ patients (61.17%), and 132 BHR- patients (25.29%) (P<.001). The areas under the curve (AUCs) of variables used singly for a BHR diagnosis were lower than 0.77. Using joint models of FEF50%, FEF75%, or FEF25%-75% with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs (P <.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (P<.001 for all). In subjects with chest tightness, the combination of FEF50% or FEF25%-75% with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively (P <.001 for all versus the univariate AUCs). Conclusion: FENO combined with FEF50% and FEF25%-75% predict BHR in patients with normal FEV1. FEF25%-75%. FEF50%, or FEF25%-75% together with EOS also can potentially suggest asthma in patients with chest tightness.