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Efficacy of Immune Checkpoint Inhibitors in Combination With Platinum-Based Doublet Chemotherapy for Extensive-Stage
Kosuke Sakai1, Shigeru Ishii1, Shin Yokosuka1
1Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Background:
The prognosis of small-cell lung cancer (SCLC) remains poor, particularly in patients with extensive-stage SCLC. The IMpower133 and CASPIAN trials revealed the efficacy of immune checkpoint inhibitors (ICIs) in extensive-stage SCLC patients with good performance status (PS). The aim of this study was to investigate the efficacy of ICIs in patients with poor PS.
Patients And Methods:
Patients with extensive-stage SCLC who visited Saitama Medical Center, Saitama Medical University (Kawagoe, Japan) (September 2019-December 2022) were enrolled and followed up until February 2024. Objective response rate (ORR) and overall survival (OS) were compared between patients who received platinum-based doublet chemotherapy with an ICI (atezolizumab or durvalumab; ICI group) and those treated with platinum-based doublet chemotherapy alone (non-ICI group). Results were stratified by the Eastern Cooperative Oncology Group performance status (ECOG-PS) (i.e., 0-1 and 2-3).
Results:
A total of 74 patients were included in the study (median OS: 327 days). In patients with ECOG-PS 0-1, ORR was 76.5% and 56.5% in the ICI group (n = 17) and non-ICI group (n = 23), respectively; OS was 406 and 379 days, respectively. In patients with ECOG-PS 2-3, ORR was 93.3% and 56.3% in the ICI group (n = 15) and non-ICI group (n = 16), respectively; OS was 446 days and 169 days, respectively. This evidence indicates that the addition of an ICI significantly improved OS (p = 0.00661) and enhanced ORR.
Conclusion:
In patients with extensive-stage SCLC and ECOG-PS 2-3, the addition of atezolizumab or durvalumab to platinum-doublet chemotherapies improved the ORR, resulting in a better prognosis. These findings suggest that chemoimmunotherapy may be a feasible treatment option beyond the ideal clinical trial populations, addressing an unmet clinical need.
Insights
Immune checkpoint inhibitors (ICIs) combined with chemotherapy significantly improved outcomes for extensive-stage small-cell lung cancer (SCLC) patients with poor performance status (PS). This chemoimmunotherapy approach offers a new treatment option for this patient group.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Trials
Background:
- Prognosis for small-cell lung cancer (SCLC), especially extensive-stage, remains poor.
- Immune checkpoint inhibitors (ICIs) show efficacy in extensive-stage SCLC with good performance status (PS).
- Limited data exists on ICI efficacy in extensive-stage SCLC patients with poor PS.
Purpose of the Study:
- To investigate the efficacy of ICIs in extensive-stage SCLC patients with poor performance status (PS).
- To compare outcomes between chemotherapy plus ICI versus chemotherapy alone in SCLC patients stratified by ECOG-PS.
Main Methods:
- Retrospective study of 74 extensive-stage SCLC patients (September 2019-February 2024).
- Comparison of objective response rate (ORR) and overall survival (OS) between ICI group (chemotherapy + atezolizumab/durvalumab) and non-ICI group (chemotherapy alone).
- Stratification by Eastern Cooperative Oncology Group performance status (ECOG-PS): 0-1 and 2-3.
Main Results:
- In patients with ECOG-PS 2-3, the ICI group showed a higher ORR (93.3% vs. 56.3%) and significantly longer OS (446 days vs. 169 days).
- In patients with ECOG-PS 0-1, the ICI group also demonstrated improved ORR (76.5% vs. 56.5%) and OS (406 days vs. 379 days).
- The addition of an ICI significantly improved OS (p=0.00661) and enhanced ORR across patient groups.
Conclusions:
- Chemoimmunotherapy with atezolizumab or durvalumab improves ORR and prognosis in extensive-stage SCLC patients with ECOG-PS 2-3.
- These findings suggest chemoimmunotherapy is a feasible treatment option for SCLC patients beyond typical clinical trial populations.
- This approach addresses an unmet clinical need for patients with poor performance status.
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