Real-world evidence for immunotherapy in the first line setting in small cell lung cancer
Menée en Israël dans un contexte de vie réelle à partir de données portant sur 102 patients atteints d'un cancer du poumon à petites cellules, cette étude de cohorte rétrospective évalue l'efficacité, du point de vue de la survie globale, des immunothérapies en traitement de première ligne
Objective : Despite major progress over the past decade in the field of lung cancer care, onlymild advances have occurred in Small Cell Lung Cancer (SCLC), with prognosis remainingpoor. Based on two randomized clinical trials (RCTs), two checkpoint-inhibitors have recently been approved in extensive-SCLC with moderate improvements in median overall survival (OS). However, only limited data exist regarding the impact of immunotherapy in real-world SCLC patients. This study reports the efficacy of immunotherapy in the first-line treatment of extensive-stage SCLC patients in a real-world setting. Methods : a retrospective cohort study of all patients treated for extensive-SCLC with chemotherapywith or without immunotherapy, at a single center in Israel between October-2017 andJuly-2021. Patient characteristics, adverse-events and survival analyses were conducted. Results : Of 102 patients identified, 54 patients (53%) received immunotherapy in addition tochemotherapy. 34.7% of patients had a performance status (PS) of 2-4. Patients thatreceived only chemotherapy were older, had more liver metastasis and a poorer PS. In the whole cohort, patients receiving immunotherapy had a significantly longer medianOS (353 days vs 194 days, HR=0.40 p<0.0001). After stratification by PS groups, survivalanalysis remained significantly longer in the PS 0-1 group (HR 0.43, p=0.0036), witha trend for better survival in the PS 2-3 group. Multivariate analysis validated anOS advantage with immunotherapy (HR = 0.46, p=0.004). Conclusion : We present evidence for the efficacy of immunotherapy in SCLC in a real-world setting.Although treatment groups differ in their baseline characteristics, it appears thateven some patients not included in RCTs, such as poor PS, may benefit from the additionof immunotherapy to their treatment protocol.
Lung Cancer 2022