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Real-world evaluation of first-line treatment of extensive-stage small-cell lung cancer with atezolizumab plus platinum/etoposide: a focus on patients with brain metastasis

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Abstract

Purpose

A previous real-world study conducted in China confirmed that first-line atezolizumab, in combination with etoposide/platinum (EP), leads to significantly longer progression-free survival (PFS) compared to EP alone in patients with extensive-stage small-cell lung cancer (ES-SCLC). The present study aimed to provide updated survival outcome data and evaluate the clinical efficacy of atezolizumab plus chemotherapy in ES-SCLC patients with brain metastasis (BM).

Methods

This retrospective study included 225 patients with ES-SCLC who were treated with EP alone (EP group) or a combination of EP + atezolizumab (atezolizumab group). Survival outcomes for the total study sample and patients in the BM subgroup were estimated using the Kaplan–Meier method.

Results

The atezolizumab group continued to demonstrate significantly longer PFS than the EP group (hazard ratio [HR], 0.68). The median overall survival (OS) was 26.2 months in the atezolizumab group vs. 14.8 months in the EP group (HR, 0.63). Additionally, among the BM patients in our study, the median PFS was found to be longer in the atezolizumab group (7.0 months) than in the EP group (4.1 months) (HR, 0.46). The OS of the BM patients did not differ significantly between the two treatment groups.

Conclusions

The addition of atezolizumab to EP as a first-line treatment for ES-SCLC was found to improve survival outcomes. This treatment combination may also prolong PFS in patients with BM, regardless of the administration of cranial irradiation. However, among the BM patients in our study, there was no significant difference in OS between the two treatment groups.

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Data availability

The data are available from the corresponding author by reasonable request.

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Acknowledgements

This work was supported by National Natural Science Foundation of China (82141117); The Capital’s Funds for Health Improvement and Research (2022-2-1023); The Beijing Municipal Administration of Hospitals Incubating Program (Code: PX2020045); Wu Jieping Medical Foundation (320.6750.2021-16-19), Clinical Research Fund for Distinguished Young Scholars of Beijing Cancer Hospital (QNJJ2022012); Guangzhou Life Oasis Public Service Center Research and exchange program in the field of health (1-35).

Author information

Author notes

  1. Hanxiao Chen, Xiangjuan Ma, Jie Liu, Yu Yang, Yanhui He those authors are co-first authors and contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing, China

    Hanxiao Chen, Yanhui He, Jun Zhao & Minglei Zhuo

  2. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department II of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing, China

    Xiangjuan Ma & Jian Fang

  3. Cancer Center, Shandong Public Health Clinical Center, Public Health Clinical Center Affiliated to Shandong University, Shandong University, Jinan, China

    Jie Liu

  4. Department of Oncology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China

    Yu Yang

  5. Department of Oncology, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou, China

    Yong Fang

  6. Department of Oncology, Baotou Cancer Hospital, Baotou, China

    Liping Wang

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  1. Hanxiao Chen
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Contributions

Conceptualization: Jian Fang, Jun Zhao, Minglei Zhuo; Methodology: Jie Liu, Jun Zhao, Minglei Zhuo; Formal analysis and investigation: Hanxiao Chen, Yu Yang, Yanhui He, Jian Fang; Data curation: Hanxiao Chen, Xiangjuan Ma, Jie Liu, Yu Yang, Yanhui He, Yong Fang, Liping Wang; Writing—original draft preparation: Hanxiao Chen, Yanhui He; Writing—review and editing: Hanxiao Chen, Xiangjuan Ma, Jian Fang, Jun Zhao, Minglei Zhuo; Funding acquisition: Jian Fang, Jun Zhao, Minglei Zhuo; Resources: Jian Fang; Supervision: Jun Zhao, Minglei Zhuo; Project administration: Hanxiao Chen, Jie Liu; Software: Hanxiao Chen, Xiangjuan Ma; Validation: Minglei Zhuo; Visualization: Minglei Zhuo.

Corresponding authors

Correspondence to Jian Fang, Jun Zhao or Minglei Zhuo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical statement

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Ethics Committee of Beijing Cancer Hospital (NO. 2021YJZ33-GZ01).

Informed consent

Informed consent was waived by the Ethics Committee because of the retrospective nature of the study.

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Supplementary Information

Below is the link to the electronic supplementary material.

12094_2024_3387_MOESM1_ESM.tif

Supplementary file1 Online Resource 1. Eligibility and analysis. ES-SCLC, extensive-stage small-cell lung cancer. LS-SCLC, Limited-stage small-cell lung cancer. BM, brain metastasis (TIF 270 KB)

12094_2024_3387_MOESM2_ESM.tif

Supplementary file2 Online Resource 2. Kaplan–Meier analysis of PFS (A) and OS (C) in patients (chemosensitive subgroup) treated with EP + A compared with those treated with EP alone from the first cycle to at least 4 cycles in induction therapy. PFS: HR 0.58 (95% CI 0.41–0.83), P = 0.002; aHR 0.47 (95% CI 0.32–0.68), P < 0.001; OS: HR 0.53 (0.31–0.88), P = 0.015; aHR 0.46 (95% CI 0.26–0.80), P = 0.007. The figure also presents the results of Kaplan–Meier analysis of PFS (B) and OS (D) in patients (maintenance subgroup) treated with EP + A from the first cycle to at least 4 cycles in induction therapy and at least 1 cycle of atezolizumab in maintenance therapy compared with those treated with EP alone from the first cycle to at least 4 cycles in induction therapy. PFS: HR 0.43 (95% CI 0.28–0.65), P < 0.001; aHR 0.35 (95% CI 0.22–0.55), P < 0.001. OS: HR 0.40 (0.21–0.73), P = 0.004; aHR 0.40 (0.20–0.74), P = 0.005 (TIF 782 KB)

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Chen, H., Ma, X., Liu, J. et al. Real-world evaluation of first-line treatment of extensive-stage small-cell lung cancer with atezolizumab plus platinum/etoposide: a focus on patients with brain metastasis. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03387-7

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