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Comparative Efficacy of First-Line Therapeutic Options for ES-SCLC: An Indirect Comparison Using

Lorenzo Gasperoni¹, Tiziano Lupi^2,3, Luna Del Bono⁴

¹Pharmaceutical Department, USL Toscana Centro, 59100 Prato, Italy.

|June 26, 2026

Summary

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Comparing the Survival Analysis of Two or More Groups

Comparing the Survival Analysis of Two or More Groups

Survival analysis is a cornerstone of medical research, used to evaluate the time until an event of interest occurs, such as death, disease recurrence, or recovery. Unlike standard statistical methods, survival analysis is particularly adept at handling censored data—instances where the event has not occurred for some participants by the end of the study or remains unobserved. To address these unique challenges, specialized techniques like the Kaplan-Meier estimator, log-rank test, and Cox...

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For extensive-stage small cell lung cancer (ES-SCLC), serplulimab plus chemotherapy shows the most promising overall survival benefit among first-line immune checkpoint inhibitor (ICI) regimens. Durvalumab and atezolizumab remain effective standards of care, but head-to-head trials are needed.

Area of Science:

Oncology
Clinical Trials
Immunotherapy

Background:

Extensive-stage small cell lung cancer (ES-SCLC) has a poor prognosis, with limited survival rates.
First-line treatment for ES-SCLC has been advanced by immune checkpoint inhibitors (ICIs) combined with chemotherapy.
Optimal first-line ICI regimen choice remains undefined due to a lack of head-to-head comparative trials.

Purpose of the Study:

To conduct an indirect treatment comparison of first-line immune checkpoint inhibitor (ICI)-based regimens for extensive-stage small cell lung cancer (ES-SCLC).
To evaluate and compare the overall survival (OS) benefits of various ICI-based regimens using reconstructed individual patient data (IPD).

Main Methods:

Systematic literature search for phase III randomized controlled trials (RCTs) of first-line ICI regimens in ES-SCLC.

Keywords:

extensive-small cell lung cancer indirect comparison restricted mean survival time

Related Experiment Videos

Reconstruction of individual patient data (IPD) from Kaplan-Meier curves using the IPDfromKM algorithm.

Indirect treatment comparisons using Cox proportional hazards models and restricted mean survival time (RMST) analysis.

Main Results:

All evaluated ICI-based regimens, except ipilimumab, improved overall survival (OS) compared to chemotherapy alone.
Serplulimab demonstrated the most significant OS benefit (HR 0.55), showing approximately 4 months gain over chemotherapy.
Durvalumab and atezolizumab also showed OS benefits, while tiragolumab addition to atezolizumab offered no significant advantage.

Conclusions:

Serplulimab plus chemotherapy may offer the most favorable OS in first-line ES-SCLC treatment among current ICI regimens.
Durvalumab and atezolizumab are established standards of care for ES-SCLC.
Prospective head-to-head comparative studies are essential to definitively establish optimal first-line ICI therapy for ES-SCLC.