The study evaluated 27 patients with KRAS-mutated advanced non-small cell lung cancer (NSCLC) who received a late-line combination of sintilimab (200 mg intravenously every 3 weeks) and anlotinib (12 mg orally daily) after at least one prior treatment. With a median follow-up of 30.3 months, median progression-free survival (PFS) was 7.96 months (95% CI: 5.6–10.3) and median overall survival (OS) was 12.4 months (95% CI: 8.2–16.6). The objective response rate (ORR) reached 33.3% and the disease control rate was 92.6%. Patients without prior antiangiogenic therapy had significantly better PFS (9.1 vs. 3.0 months, HR = 0.29, p < 0.001) and OS (13.5 vs. 5.7 months, HR = 0.42, p = 0.025). Grade 3-4 adverse events occurred in 25.9% of patients, mainly hypertension (11.1%) and hand-foot syndrome (7.4%), with no fatalities. The combination showed promising efficacy and manageable toxicity without chemotherapy.