Treatment and outcome of 432 patients with extensive-stage small cell lung cancer in first, second and third line – Results from the prospective German TLK cohort study

Abstract

Despite intensive research, the therapeutic options in extensive-stage small cell lung cancer (SCLC) are still limited. Data from routine clinical practice, so-called "real-world data", are centrally important to assess and improve the standard of care. We present prospectively documented data on systemic first-, second-and third-line treatment, number of treatment lines and outcome parameters of patients treated by medical oncologists in Germany. Materials and methods: This is a descriptive analysis on 432 patients with extensive-stage SCLC enrolled at start of first-line therapy into the prospective German clinical cohort study TLK (Tumour Registry Lung Cancer). Patients were recruited by 87 sites between February 2010 and December 2013 and followed-up individually for 3 years. Results: The majority of patients (93%) received a first-line platinum-based combination therapy. Carboplatin plus etoposide was documented more frequently than cisplatin plus etoposide (46 vs. 35%); patients receiving carboplatin were older (68 vs. 63 years) and more often presented with poorer performance status (17 vs. 11% ECOG ≥ 2). Both regimens yielded similar response and survival rates. Median first-line overall survival (OS) was 10.2 months (95% confidence interval [CI] 8.6-12.3) for carboplatin plus etoposide and 12.2 months (95% CI 10.1-14.7) for cisplatin plus etoposide. Most patients (77%) would have been eligible for participation in a clinical trial. 50% of the patients received a second and 22% a third line of treatment. Median second-line OS was 5.8 months (95% CI 4.8-7.5), median third-line OS 5.7 months (95% CI 3.8-7.0). Conclusion: To our knowledge, this is the first study of prospectively documented patients with extensive-stage SCLC in routine clinical practice. We present treatment algorithms as well as outcome parameters for a large cohort in first-, second-and third-line treatment. The survival times and response rates reported in this routine setting correspond to the respective measures from large prospective trials.

Lung immune prognostic index as a prognostic factor in patients with small cell lung cancer

“…Second, the rate of third‐line treatment in the LIPI 0 group was higher than that in the LIPI 1 group (56.5% vs. 26.3%, P = 0.018). The prospective German Tumor Registry Lung Cancer cohort study reported that the median third‐line OS of patients who received third‐line treatment was 5.8 months . We reported that the median third‐line OS of patients who received third‐line treatment was 5.2 months .…”

Treatment patterns and survival outcomes for small-cell lung cancer patients – a Swedish single center cohort study

“…The purpose of the present Swedish single center cohort study was to analyze real-world data on SCLC treatment patterns in the 1st, 2nd and 3rd line of therapy, as well as outcomes of re-challenge with PDCT. We wanted to investigate how patients at the Karolinska University Hospital have been treated and compare survival outcomes with previous studies [16,17].…”

“…Given this background, the aim of the present large retrospective study was to evaluate the treatment patterns for SCLC patients in 1st, 2nd and 3rd line as well as the outcomes of re-challenge with PDCT compared to previous experiences [16,17]. The purpose was also to investigate if there was an association between clinical characteristics and outcomes in SCLC patients in a real-world setting.…”

Small Cell Lung Cancer: Advances in Diagnosis and Management

“…In one analysis of 432 patients with ES-SCLC who received first-line therapy, 50% of patients received second-line therapy and only 22% received thirdline therapy. 92 To increase potential impact, earlier implementation of immunotherapy was explored, with disappointing results. CheckMate-331 was a randomized phase III trial for patients with SCLC that progressed on or relapsed after platinum-based therapy (second-line setting).…”