Objective To observe the clinical efficacy of toripalimab combined with bronchial arterial chemoembolization (BACE) and intensity-modulated radiotherapy (IMRT) in advanced lung cancer.

Methods A prospective single-arm trial was conducted in 104 patients with programmed death-ligand 1 (PD-L1)-positive, driver gene-negative non-small cell lung cancer (NSCLC) in stages of ⅢB to Ⅳ admitted to the First People's Hospital of Guangyuan City of Sichuan Province. All patients received toripalimab combined with BACE and IMRT. Clinical efficacy, symptom improvement time, tumor biomarker levels carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), cytokeratin 19 fragment (CYFRA21-1), neuron-specific enolase (NSE), T-lymphocyte subsets (CD3⁺, CD4⁺, CD4⁺/CD8⁺), survival outcomes, and adverse events were analyzed.

Results Among 102 patients, the objective response rate (ORR) was 75.49%, disease control rate (DCR) was 90.20%, survival rate was 68.63%, and 12-month progression-free survival rate was 62.75%. The overall incidence of adverse events of any grade was 72.55%. Post-BACE, post-IMRT, and post-toripalimab treatment levels of CEA, CYFRA21-1, CA199, and NSE were significantly lower than baseline data (P < 0.05), with the lowest levels observed after toripalimab treatment compared to post-BACE and post-IMRT (P < 0.05). CD3⁺, CD4⁺, and CD4⁺/CD8⁺ decreased after BACE, IMRT and toripalimab therapy, but they were increased following toripalimab therapy compared with the other two therapies (P < 0.05).

Conclusion Toripalimab combined with BACE and IMRT demonstrates significant clinical efficacy and acceptable tolerability in PD-L1-positive, driver gene-negative NSCLC in stages of ⅢB to Ⅳ, serving as a preferred consolidation regimen after unresectable chemoradiotherapy.