| Contributors: |
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. Department of Medical Oncology, University Hospital Basel, Basel, Switzerland. Department of Medical Oncology, Inselspital, University Hospital Bern, Bern, Switzerland. Department of Medical Oncology, Cantonal Hospital Winterthur, Winterthur, Switzerland. Center Oncology/Hematology, Department Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland. Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland. Division of Oncology/Hematology, Department Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland. Department of Oncology, HFR Fribourg - Hôpital fribourgeois, Fribourg, Switzerland. Oncology/Hematology, Department Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland. Department of Oncology, Cantonal Hospital Lucerne, Lucerne, Switzerland. Swiss Group for Clinical Cancer Research (SAKK), Competence Center, Bern, Switzerland. Department of Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. Leicester Royal Infirmary - University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. Medical Oncology Department, Beatson West of Scotland Cancer Centre NHS, Greater Glasgow and Clyde, Glasgow, United Kingdom. Clinical Oncology Department, The Royal Marsden Hospital - NHS Foundation Trust, London, United Kingdom. Medical Oncology Department, The Royal Marsden Hospital - NHS Foundation Trust, London, United Kingdom. Clinical Oncology Department, Velindre Cancer Centre - Velindre NHS University Trust - NHS Wales, Cardiff, United Kingdom. Oncology Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom. Oncology Department, University Hospital Southampton- NHS Foundation Trust, Southampton, United Kingdom. Medical Oncology Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom. Oncology Department, Huddersfield Royal Infirmary - Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom. Oncology Department, Northwick Park Hospital - London North West University Healthcare NHS Trust, Harrow, Middlesex, United Kingdom. Department Of Medical Oncology, The Christie NHS Foundation Trust and Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom. |
| Description: |
INTRODUCTION: SCLC is characterized by aggressiveness and limited treatment options, especially in extensive-stage SCLC (ES-SCLC). Immunotherapy added to the platinum-etoposide combination has recently become standard in this setting. This retrospective study aims to evaluate the real-world effectiveness of chemo-immunotherapy in patients with ES-SCLC, focusing on subpopulations excluded from clinical trials. METHODS: A retrospective binational multicenter study was conducted, involving consecutive patients with ES-SCLC from 10 British and 10 Swiss institutions. Patients received platinum-etoposide chemotherapy in combination with immunotherapy (atezolizumab or durvalumab). Patient, tumor, and treatment details were collected. Overall survival (OS), progression-free survival, objective response rate, and safety outcomes were analyzed. RESULTS: A total of 436 patients were included. One hundred forty-two patients (32.6%) in our cohort would not have been eligible for the pivotal registrational trials owing to an Eastern Cooperative Oncology Group performance status of 2 or higher, autoimmune disease, active brain metastases, or steroid use. Most patients received carboplatin (96.8%) and atezolizumab (97.9%). The median progression-free survival was 5.5 months and the median OS was 9.3 months. The two-year OS was 14%. Patients with liver or bone metastases or an Eastern Cooperative Oncology Group performance status of 2 or higher had worse survival outcomes. Treatment-related adverse events were reported in 222 patients (51%) whereas immune-related adverse events occurred in 95 patients (22%). Three out of five grade 5 immune-related adverse events were caused by pneumonitis. CONCLUSIONS: To our knowledge, this is the largest real-world cohort of patients treated with chemo-immunotherapy for ES-SCLC. Although one-third of patients would not have been eligible for pivotal trials, the survival outcomes in our cohort are similar to those in registrational trials. In particular, the number of long-term survivors and ... |