Real-world survival outcomes with first-line chemoimmunotherapy and biomarker analysis in extensive-stage small-cell
Emmanouil Panagiotou1, Ioannis Athanasios Vathiotis2, Austin Montgomery3
1Third Department of Internal Medicine, Sotiria Thoracic Diseases Hospital of Athens, National and Kapodistrian University of Athens, 152, Mesogion Ave., 11527, Athens, Greece.
Purpose:
The approval of programmed death-ligand 1 (PD-L1) inhibitors in the first line of treatment has transformed the therapeutic landscape of extensive-stage small cell lung cancer (ES-SCLC); real-world (rw) evidence of clinical benefit is currently limited. In this study, we investigated the rw efficacy of first-line chemoimmunotherapy and the role of potential biomarkers.
Methods/Patients:
We retrospectively assessed patients with SCLC receiving first-line chemoimmunotherapy at Sotiria Thoracic Diseases Hospital of Athens, Athens, Greece. Kaplan-Meier curves were used to calculate real-world progression-free survival (rwPFS) and real-world overall survival (rwOS). Cox proportional hazards regression analysis was utilized to identify associations between patient characteristics and outcomes.
Results:
188 patients were included. Median rwPFS was 6.5 months (95% CI 5.8-7.1 months) and median rwOS was 11.2 months (95% CI 9.1-12.0 months). rwOS was higher in the atezolizumab group compared with the durvalumab group (median, 12.0 vs 9.2 months; hazard ratio [HR], 1.51; 95% CI 1.06-2.15; p = 0.02), similar results were observed for rwPFS (median, 6.5 vs. 6.0 months, HR, 1.55; 95% CI 1.10-2.16; p = 0.01). In multivariate analysis, the difference between atezolizumab and durvalumab was not statistically significant, while lung, bone and liver metastases, ECOG PS, LDH and NLR were associated with an increased risk of death. Associations were utilized for the generation of a novel prognostic score with good discriminatory power (C-statistic: 0.73).
Conclusions:
Real-world efficacy of first-line chemoimmunotherapy in patients with ES-SCLC is comparable to randomized trials. The association between prognostic scores and survival outcomes in ES-SCLC should be explored in prospective studies.Query.
Insights
Real-world data shows first-line chemoimmunotherapy for extensive-stage small cell lung cancer (ES-SCLC) offers clinical benefits comparable to clinical trials. Prognostic factors significantly impact survival, suggesting a need for further research into novel prognostic scores.
Area of Science:
- Oncology
- Immunotherapy
- Clinical Research
Background:
- First-line programmed death-ligand 1 (PD-L1) inhibitors have changed extensive-stage small cell lung cancer (ES-SCLC) treatment.
- Limited real-world (rw) data exists on the clinical benefit of these therapies.
Purpose of the Study:
- To investigate the rw efficacy of first-line chemoimmunotherapy in ES-SCLC patients.
- To identify potential biomarkers influencing treatment outcomes.
Main Methods:
- Retrospective assessment of 188 SCLC patients receiving first-line chemoimmunotherapy.
- Kaplan-Meier curves for real-world progression-free survival (rwPFS) and real-world overall survival (rwOS).
- Cox proportional hazards regression for outcome associations with patient characteristics.
Main Results:
- Median rwPFS was 6.5 months; median rwOS was 11.2 months.
- Atezolizumab showed higher rwOS and rwPFS compared to durvalumab, though not statistically significant in multivariate analysis.
- Lung, bone, and liver metastases, ECOG PS, LDH, and NLR were associated with increased mortality risk.
- A novel prognostic score demonstrated good discriminatory power (C-statistic: 0.73).
Conclusions:
- Real-world efficacy of first-line chemoimmunotherapy in ES-SCLC aligns with findings from randomized trials.
- The prognostic value of identified factors and scores warrants further investigation in prospective studies.
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