Background

The application of immune checkpoint inhibitors (ICIs) in treating patients with extensive-stage small-cell lung cancer (ES-SCLC) has brought us new hope, but the real-world outcome is relatively lacking. Our aim was to investigate the clinical use, efficacy, and survival benefit of ICIs in ES-SCLC from real-world data analysis.

Methods

A retrospective analysis of ES-SCLC patients was conducted between 2012 and 2022. Progression-free survival (PFS) and overall survival (OS) were assessed between groups to evaluate the value of ICIs at different lines of treatment. PFS1 was defined as the duration from initial therapy to disease progression or death. PFS2 was defined as the duration from the first disease progression to the second disease progression or death.

Results

One hundred and eighty patients with ES-SCLC were included. We performed landmark analysis, which showed that compared to the second-line and subsequent-lines ICIs-combined therapy group (2SL-ICIs) and non-ICIs group, the first-line ICIs-combined therapy group (1L-ICIs) prolonged OS and PFS1. There was a trend toward prolonged OS in the 2SL-ICIs group than in the non-ICIs group, but the significance threshold was not met (median OS 11.94 months vs. 11.10 months, P = 0.14). A longer PFS2 was present in the 2SL-ICIs group than in the non-ICIs group (median PFS2 4.13 months vs. 2.60 months, P < 0.001).

Conclusion

First-line ICIs plus chemotherapy should be applied in clinical practice. If patients did not use ICIs plus chemotherapy in first-line therapy, the use of ICIs in the second line or subsequent lines of treatment could prolong PFS2.

中文翻译：

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免疫检查点抑制剂不同治疗时间段对广泛期小细胞肺癌患者预后的影响

背景

免疫检查点抑制剂（ICIs）在治疗广泛期小细胞肺癌（ES-SCLC）患者中的应用给我们带来了新的希望，但现实世界的结果相对缺乏。我们的目的是通过真实世界的数据分析来研究 ICI 在 ES-SCLC 中的临床应用、疗效和生存获益。

方法

对 2012 年至 2022 年间的 ES-SCLC 患者进行回顾性分析。评估组间无进展生存期 (PFS) 和总生存期 (OS)，以评估不同治疗线下 ICI 的价值。 PFS1 定义为从初始治疗到疾病进展或死亡的持续时间。 PFS2定义为从第一次疾病进展到第二次疾病进展或死亡的持续时间。

结果

包括 180 名 ES-SCLC 患者。我们进行了里程碑式的分析，结果显示，与二线及后续ICIs联合治疗组（2SL-ICIs）和非ICIs组相比，一线ICIs联合治疗组（1L-ICIs）延长了OS和 PFS1。 2SL-ICIs 组的 OS 比非 ICI 组有延长的趋势，但未达到显着性阈值（中位 OS 11.94 个月 vs. 11.10 个月，P  = 0.14）。 2SL-ICIs 组的 PFS2 比非 ICI 组更长（中位 PFS2 4.13 个月 vs. 2.60 个月，P  < 0.001）。

结论

临床应采用一线ICIs联合化疗。如果患者在一线治疗中未使用 ICI 联合化疗，则在二线或后续治疗中使用 ICI 可以延长 PFS2。