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Multicenter Cohort Study of Original or Substitute Systemic Therapy With or Without Brain Radiotherapy for
Shuangqing Lu1,2, Jingyi Jia3, Kai Ren4
1Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China.
Summary
Continuing original therapy plus brain radiotherapy (BRT) improves survival for extensive-stage small cell lung cancer (ES-SCLC) patients with brain-only progression. This strategy offers better overall survival and progression-free survival compared to switching therapies.
Area of Science:
- Oncology
- Neuro-oncology
- Clinical Trial Design
Background:
- Optimal second-line treatment for extensive-stage small cell lung cancer (ES-SCLC) with brain-only progression (BOP) is unclear.
- Evaluating continuation versus switching systemic therapy is crucial for improving patient outcomes.
Purpose of the Study:
- To compare the efficacy of continuing original systemic therapy versus switching strategies in ES-SCLC patients with BOP.
- To identify the best second-line treatment approach for this patient population.
Main Methods:
- Multicenter cohort study of 203 ES-SCLC patients with BOP.
- Comparison of three second-line strategies: original therapy plus BRT (OTP + BRT), substitution therapy plus BRT (ST + BRT), and substitution therapy alone (ST).
- Inverse probability of treatment weighting (IPTW) used for balancing baseline characteristics; primary endpoint was overall survival from second-line initiation (OS2).
Main Results:
- OTP + BRT significantly improved median OS2 (14.7 months) compared to ST (10.2 months) and ST + BRT (9.8 months).
- OTP + BRT also showed improved median second-line progression-free survival (PFS) (8.0 months) versus ST (4.0 months).
- Prior immunotherapy and longer initial PFS (≥7.5 months) were associated with the greatest benefit from OTP + BRT.
Conclusions:
- Continuing original systemic therapy combined with BRT is superior to switching systemic therapy for ES-SCLC patients with BOP.
- This approach supports a site-of-progression-directed strategy, controlling CNS disease while maintaining systemic efficacy.
- No significant difference in survival was noted between whole-brain radiotherapy and stereotactic radiosurgery.
