Trends in Response Rate and Survival in Small-Cell Lung Cancer Patients Between 1997 and 2017
Menée en France à partir de données portant sur 529 patients atteints d'un cancer du poumon à petites cellules, cette étude analyse, sur la période 1997-2017, les facteurs associés à l'évolution de la réponse aux chimiothérapies et de la survie associée
Introduction : Median survival of small-cell lung cancer (SCLC) patients is usually around 1 year. The advent of new drugs may have slightly improved their prognosis. We aimed to assess whether SCLC response to chemotherapy and survival had changed over time. Methods : Consecutive SCLC patients were included at Grenoble University Hospital, France. We compared the patients’ characteristics, response to chemotherapy and survival between 1997-2009 (period 1) and 2010-2017 (period 2). Results : A total of 529 patients were identified, of whom 498 received a first line of chemotherapy and 279 a second line. The majority (n = 290, 58%) had extensive disease. The objective response rate (ORR) to first-line chemotherapy in metastatic patients was 63% in period 1 and 62% in period 2; the ORRs to second-line chemotherapy were 39% and 29%, respectively. Median overall survival from first-line chemotherapy was 13.2 months (interquartile range [IQR] 7.4–24.4) in period 1 and 11.2 months (IQR 7.1–21.2) in period 2. Mortality in these two periods did not differ significantly even after adjustment for prognostic factors (hazard ratio [HR] = 0.82, 95% confidence interval [CI] 0.66–1.00). The factors independently associated with death were cardiovascular comorbidities (HR = 1.28 [95%CI 1.05–1.55]), liver comorbidities (HR = 1.31 [95%CI 1.03–1.65]), poor ECOG performance status (3–4vs. 0–1, HR = 2.45 [95%CI 1.83–3.30]) and extensive disease (HR = 2.69 [95%CI 2.18–3.33]). Conclusions : Since 1997, there has been no improvement in the survival or response rate to chemotherapy of SCLC patients. There is a desperate need for new approaches in this setting.apy was 74% in 1997-2009 and 71% in 2010-2017.?In metastatic patients median survivals were 8.6 months and 8.9 months respectively.?It highlights a lack of improvement in response and survival from 1997 to 2017.?Ongoing clinical trials are encouraging.