Real-world survival outcomes to first-line chemoimmunotherapy and biomarker analysis in extensive-stage small-cell lung cancer

Abstract

Background Recent approval of programmed death-ligand 1 (PD-L1) inhibitors in the first line of treatment has transformed the therapeutic landscape of extensive-stage small cell lung cancer (ES-SCLC); real-world (rw) evidence of efficacy is currently limited. Patients and Methods: We retrospectively assessed patients with SCLC, large cell neuroendocrine carcinoma (LCNEC) or combined histology receiving chemoimmunotherapy in the first-line treatment setting at “Sotiria” General Hospital for Chest Diseases, Athens, Greece. Patient demographics and disease characteristics were extracted using a standardized form. Kaplan-Meier curves were used to calculate rw progression-free survival (rwPFS) and rw overall survival (rwOS). Cox proportional hazards regression analysis was utilized to identify associations between patient characteristics and outcome. Results One hundred patients were included in the analysis. Median rwPFS was 7.2 months (95% CI, 6.7–12.0 months) and median rwOS was 14.4 months (95% CI, 9.4–18.6 months); efficacy metrics were similar between patients treated with durvalumab and atezolizumab. In the multivariate analysis, the number of metastatic sites was associated with increased risk of death (HR, 1.47; 95% CI, 1.11–1.94; p = 0.007), while BMI was associated with decreased risk (HR, 0.89; 95% CI, 0.81–0.97; p = 0.008). Exploratory biomarker analysis revealed a correlation between different prognostic scores (RMH, GRIM, LIPI, and EPSILoN) and rwOS. Conclusion Real-world data confirm the efficacy of first-line chemoimmunotherapy in patients with ES-SCLC. The association between prognostic scores and survival outcomes in ES-SCLC should be explored in prospective studies.