Immunotherapy for small-cell lung cancer

Abstract

Small-cell lung cancer (SCLC) is one of the most prognostically unfavorable malignant tumors for which an effective targeted inhibitor has not yet been found. Cytotoxic therapy for SCLC has not changed in the last thirty years. Immunotherapy is a fundamentally new method of treatment of malignant tumors, which has proven its effectiveness in various solid tumors. Fundamental prerequisites for the efficacy of immunotherapy in SCLC include a high level of mutational load and paraneoplastic syndromes typical for SCLC (Lambert - Eaton syndrome, etc.), leading to immunization against the tumor; factors that may adversely affect the efficacy of immunotherapy are low levels of PD-L1 expression, low content of T-lymphocytes infiltrating the tumor, and loss of histocompatibility of SCLC antigens by tumor cells. The first studies that studied the efficacy of CTLA-4 inhibitors in the first line of therapy of SCLC and PD-L1/PD-1 inhibitors during progression after the first line showed ambiguous results. However, the study to evaluate the efficacy of athezolizumab (antibody to PD-L1 receptor) in combination with chemotherapy in the first line of SCLC, where for the first time in 30 years in the studies of phase 3 at disseminated SCLC a significant increase in the total survival rate was shown. The study of immune control point inhibitors in SCLC, both localized and disseminated, continues, the prospects of immunotherapy in SCLC are already clearly defined, and further development and improvement in one of the most adverse forms of cancer is expected.

Фармакоэкономическая Оценка Лекарственного Обеспечения Химиотерапии Мелкоклеточного Рака Легкого

“…Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, small cell lung cancer develops quickly, is diagnosed late, and forms metastases aggressively; the disease is characterized by a severe course of treatment when symptoms appear, the survival rate of patients is relatively low. That is why, research interest in this disease is growing and will continue to grow, since every year the number of people suffering from this pathology increases (Kuzminov et al 2019).…”

Treatment of advanced small cell lung cancer. Clinical case and literature review

“…При первом промежуточном анализе было получено достоверное увеличение как ВБП, так и ОВ. После медианы наблюдения в 13,9 мес медиана ОВ в группе атезолизумаба составила 12,3 мес (95% доверительный интервал -ДИ 10,8-15,8), а в группе плацебо -10,3 мес (95% ДИ 9,3-11,3; р=0,0069) [19,20] в группе плацебо -12,6% против 5,4% (рис. 3).…”

“…Частота объективных ответов в группах атезолизумаба и плацебо в целом была сопоставима: 60,2 и 64,4% соответственно. Но, в свою очередь, доля продолжающихся ответов была значительно выше в группе атезолизумаба -9,1% против 2,3% в группе плацебо при медиане длительности наблюдения 22,9 мес [19,20].…”

“…Иммуноопосредованные НЯ развились у 41,4% больных в группе атезолизумаба и у 24,5% больных в группе плацебо. Из иммуноопосредованных НЯ следует отметить сыпь (20,2%), гипотиреоидизм (12,6%) и гепатит (7,6%) [19,20].…”