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. 2024 Apr 29;12(5):474.
doi: 10.3390/vaccines12050474.

A Clinical Analysis of Anti-Programmed Death-Ligand 1 (PD-L1) Immune Checkpoint Inhibitor Treatments Combined with Chemotherapy in Untreated Extensive-Stage Small-Cell Lung Cancer

Ping-Chih Hsu  1   2 , Bing-Chen Wu  1 , Chin-Chou Wang  2   3 , Li-Chung Chiu  1   2 , Chiung-Hsin Chang  1   4 , Ping-Chi Liu  5 , Chiao-En Wu  2   6 , Scott Chih-Hsi Kuo  1   2 , Jia-Shiuan Ju  1 , Allen Chung-Cheng Huang  1 , Yu-Ching Lin  2   7   8 , Cheng-Ta Yang  1   5   9 , How-Wen Ko  1   2
Affiliations

A Clinical Analysis of Anti-Programmed Death-Ligand 1 (PD-L1) Immune Checkpoint Inhibitor Treatments Combined with Chemotherapy in Untreated Extensive-Stage Small-Cell Lung Cancer

Ping-Chih Hsu et al. Vaccines (Basel). .

Abstract

Real-world clinical experience of using anti-programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs) combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer (SCLC) patients has rarely been reported. In this study, we aimed to perform a retrospective multicenter clinical analysis of extensive-stage SCLC patients receiving first-line therapy with anti-PD-L1 ICIs combined with chemotherapy. Between November 2018 and March 2022, 72 extensive-stage SCLC patients receiving first-line atezolizumab or durvalumab in combination with chemotherapy, according to the cancer center databases of Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals, were retrospectively included in the analysis. Twenty-one patients (29.2%) received atezolizumab and fifty-one (70.8%) received durvalumab. Objective response (OR) and disease control (DC) rates of 59.7% and 73.6%, respectively, were observed with first-line ICI plus chemotherapy. The median progression-free survival (PFS) was 6.63 months (95% confidence interval (CI), 5.25-8.02), and the median overall survival (OS) was 16.07 months (95% CI, 15.12-17.0) in all study patients. A high neutrophil-to-lymphocyte ratio (NLR; >4) and a high serum lactate dehydrogenase (LDH) concentration (>260 UL) were identified as independent unfavorable factors associated with shorter OS in the multivariate analysis. Regarding safety, neutropenia was the most common grade 3 treatment-related adverse event (AE), but no treatment-related deaths occurred in the study patients. First-line anti-PD-L1 ICIs combined with chemotherapy are effective and safe for male extensive-stage SCLC patients. Further therapeutic strategies may need to be developed for patients with unfavorable outcomes (e.g., baseline high NLR and serum LDH level).

Keywords: atezolizumab; durvalumab; immunotherapy; programmed death-ligand 1 (PD-L1); small-cell lung cancer (SCLC).

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Conflict of interest statement

All of the authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of study patient retrieval.
Figure 2
Figure 2
Efficacy of first-line anti-PD-L1 ICIs combined with chemotherapy: (A) treatment response to first-line anti-PD-L1 inhibitors in combination with chemotherapy; (B) median PFS in patients treated with first-line anti-PD-L1 inhibitors combined with chemotherapy; (C) the median OS of all patients.
Figure 3
Figure 3
Overall survival (OS) was analyzed based on the neutrophil-to-lymphocyte ratio (NLR) (>4) and serum lactate dehydrogenase (LDH) level (>260 UL) via Kaplan–Meier survival curves: (A) comparison of the median OS between patients with different NLRs (HR = 0.143; 95% CI, 0.068–0.299; p < 0.001); (B) comparison of the median OS between patients with different LDH levels (HR = 0.143; 95% CI = 0.094–0.358; p < 0.001).
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