Patterns of Disease Progression after Carboplatin/Etoposide + Atezolizumab in Extensive-Stage Small-Cell Lung Cancer (ES-SCLC)

Higgins, Kristin; Liu, S.V.; Wen, Yu; Brockman, Megan M.; Johnson, Amy W.; Bara, Ilze; Bradley, J.D.

doi:10.1016/j.ijrobp.2020.09.020

Cited by 23 publications

(17 citation statements)

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“… 18 , 19 With the report that the most dominant pattern of SCLC progression was at initial thoracic sites of the disease, it is also likely that tRT provides treatment consolidation to residual tumor cells that might have escaped the antitumor effect of systemic therapy. 3 , 29 Alternatively, improved OS with tRT may be accounted for by the fact that patients who received tRT had numerically lower proportion (but not statistically significant, p = 0.06) of M1c disease (American Joint Committee on Cancer TNM eighth edition M-status) than those who did not receive such treatment as found in our Supplementary Table 1 .…”

Section: Discussionmentioning

confidence: 71%

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

Elegbede

Gibson

Fung

et al. 2021

JTO Clinical and Research Reports

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Introduction The real-world data evaluating treatment outcomes of atezolizumab plus carboplatin-etoposide chemotherapy (atezolizumab) for extensive-stage SCLC (ESCLC) are lacking. Our objective was to evaluate real-world outcomes of ESCLC treated with atezolizumab. Methods A retrospective analysis of provincial patients with ESCLC who started first-line (1L) systemic treatment was conducted. We primarily evaluated the progression-free survival (PFS) and overall survival (OS) outcomes in association with atezolizumab compared with platinum-etoposide chemotherapy (chemotherapy) while adjusting for relevant demographic and clinical factors. Adverse events (AEs) during 1L were evaluated. Results A total of 67 patients were identified. Of the 34 patients who received atezolizumab, 24% had Eastern Cooperative Oncology Group performance status greater than or equal to 2, approximately 50% were more than or equal to 65 years, 21% received cisplatin-etoposide chemotherapy before atezolizumab, and 12% had thoracic radiation (tRT). Within the atezolizumab versus chemotherapy group, the median PFS equals to 6.0 versus 4.3 months ( p = 0.03) whereas OS = 12.8 versus 7.1 months ( p = 0.01). Relative to chemotherapy, the hazard ratio (95% confidence interval) for PFS was 0.53 (0.28–1.02) and OS was 0.42 (0.20–0.88) with atezolizumab. tRT compared with no tRT receipt correlated with reduced death risk (hazard ratio [95% confidence interval] = 0.33 [0.13–0.88]). AE-related treatment withdrawal with atezolizumab was 32% and 15% with chemotherapy ( p = 0.02). Within the tRT subgroup, 25% versus 20% in atezolizumab versus chemotherapy group, respectively, discontinued 1L owing to AE. Conclusions This is the first real-world study revealing comparable survival with that in the IMpower133 trial. Treatment discontinuation from AEs was higher with atezolizumab among Canadian patients with ESCLC. Our data suggest safe use of tRT and chemoimmunotherapy, but its efficacy for ESCLC warrants further study.

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Section: Discussionmentioning

confidence: 71%

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

Elegbede

Gibson

Fung

et al. 2021

JTO Clinical and Research Reports

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“…The percentage of enrolled patients who received PCI in the IMpower133 and KEYNOTE-604 was 11 and 13%, respectively, whilst in the CASPIAN trial, PCI was allowed only in the control arm after completion of CT, and 8% of patients in this arm received it ( 4 – 6 ). Noteworthy, in the IMpower133 trial, time to intracranial progression was longer in patients receiving CT + atezolizumab vs. CT only (20.2 vs. 10.5 months, respectively), even though they did not receive PCI (16.7 vs. 9.8 months, respectively) ( 34 ). This evidence further questioned the role of PCI in the era of chemoimmunotherapy.…”

Section: Brain Metastases In the Chemoimmunotherapy Eramentioning

confidence: 99%

First-Line Treatment for Advanced SCLC: What Is Left Behind and Beyond Chemoimmunotherapy

et al. 2022

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Small cell lung cancer (SCLC) is still a lethal disease. Three phase III randomized clinical trials (IMpower133, CASPIAN, and KEYNOTE-604) have highlighted the survival gain of adding immune checkpoint inhibitors to first-line standard chemotherapy in advanced SCLC patients. In this review, we discuss the data from the three trials above. Furtherly, we analyze issues that still need to be elucidated, like the role of biomarkers, poor performance status at baseline, the presence of brain metastases, and the platinum compound's choice. Moreover, we depict the future of SCLC first-line therapy management, focusing on new therapeutic strategies currently under investigation.

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“…The CASPIAN trial allowed PCI in the chemotherapy alone arm but only 8% (21 patients) received it (47) and although PCI was permitted in both arms of the IM-Power 133 trial, only 11% (22 patients) in each arm received it (45). The IM-Power 133 study showed that atezolizumab significantly delayed the time to intracranial progression (20.2 months versus 10.5 months, P=0.046) compared with placebo (48). Similarly, in the setting of AJCC stage III non-small cell lung cancer (NSCLC), the PACIFIC trial showed that the addition of adjuvant durvalumab reduced the incidence of BM from 11.8% to 6.3% (49).…”

Section: Pci In Es-sclcmentioning

confidence: 99%

Radiation therapy in the prevention and management of brain metastases in patients with small cell lung cancer: a narrative review

Hau¹,

Lim²,

Vinod³

et al. 2022

Chin Clin Oncol

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Patterns of Disease Progression after Carboplatin/Etoposide + Atezolizumab in Extensive-Stage Small-Cell Lung Cancer (ES-SCLC)

Cited by 23 publications

References 0 publications

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

First-Line Treatment for Advanced SCLC: What Is Left Behind and Beyond Chemoimmunotherapy

Radiation therapy in the prevention and management of brain metastases in patients with small cell lung cancer: a narrative review

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