Chemo-Immunotherapy in First Line Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Systematic Review and Meta-Analysis

Abstract

Small cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma with early metastatic potential. The standard-of-care treatment has not changed in years. Recent studies report improved progression-free survival (PFS) and overall survival (OS) with combined ICI and chemotherapy in ES-SCLC. We conducted a systematic review and meta-analysis to assess the magnitude of survival benefits. We searched MEDLINE, EMBASE, and Cochrane between 1 January 2010 and 15 July 2022 and conference proceedings from 2018 to 2022, for randomised controlled trials, evaluating chemo-ICI compared with platinum-doublet chemotherapy in untreated ES-SCLC. Outcomes assessed were PFS, OS, objective response rate (ORR), duration of response (DoR), toxicity, and health-related quality of life (HRQoL). The search identified 8061 studies, with 8 (56 publications) included in the final analysis. PFS and OS were significantly improved for patients randomised to chemo-ICI (PFS hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.70–0.80) and (OS HR 0.79, 95% CI 0.73–0.85). Subgroup analysis demonstrated a differential effect between PD-1/PD-L1 and CTLA-4 inhibitors. There was no difference in ORR and DoR. All-grade adverse events (RR 1.06, 95% CI 1.00–1.12) were similar. The addition of ICI to chemotherapy in untreated ES-SCLC results in a 22% risk reduction in death, and a 25% risk reduction in disease progression with a minimal increase in toxicity. These improvements are modest but represent progress beyond the standard of care.

Extensive Stage Small-Cell Lung Cancer with Cystic Brain Metastases: A Report of Two Cases

“…With platinum-based therapy, initial response rates were as high as 60-65%; progression-free survival (PFS) was 4.3-5.6 months. 13 With the advent of immunotherapy, IMpower133 and CASPIAN trials have shown that regardless of the PD-L1 expression, patients would benefit from ICIs. 14,15 The US Food and Drug Administration has approved atezolizumab or durvalumab in combination with platinum-based therapy as first-line treatment options for ES-SCLC.…”

Prognostic Factors and Construction of Nomogram Prediction Model of Lung Cancer Patients Using Clinical and Blood Laboratory Parameters

“…Among them, SCLC occurs in approximately 15% of all LC patients, is the most malignant form, and proliferates and metastasizes rapidly, and has a poor prognosis. 6 , 7 NSCLC has a high incidence of approximately 85% among LC diseases, and although LC is less malignant and metastasizes later than SCLC, it still has a high mortality and recurrence rate. 8 , 9 Therefore, both SCLC and NSCLC have the potential for a poor prognosis.…”

Evaluation of Real-Life Chemoimmunotherapy Combination in Patients with Metastatic Small Cell Lung Carcinoma (SCLC): A Multicentric Case–Control Study

“…Similar results were observed in the CASPIAN study with the use of durvalumab (13 months median OS in the durvalumab arm vs. 10.3 months in the placebo arm) [ 8 ]. To date, very few multicentric real-life data are available to validate these results from the phase III clinical trials and are often in small population samples [ 10 , 11 , 12 , 13 ]. The objective of this study is to evaluate the efficacy of chemoimmunotherapy as first-line therapy in a real-life cohort of patients compared to a control cohort treated with CT alone.…”