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. 2024 Dec 6;29(12):1079-1089.
doi: 10.1093/oncolo/oyae234.

Recent treatment patterns and real-world survival following first-line anti-PD-L1 treatment for extensive-stage small cell lung cancer

Jaime Shaw  1 , Xerxes Pundole  1 , Akhila Balasubramanian  1 , Erik S Anderson  1 , Malaika Pastel  1 , D Gwyn Bebb  1 , Tony Jiang  1 , Pablo Martinez  1 , Suresh S Ramalingam  2 , Hossein Borghaei  3
Affiliations

Recent treatment patterns and real-world survival following first-line anti-PD-L1 treatment for extensive-stage small cell lung cancer

Jaime Shaw et al. Oncologist. .

Abstract

Background: The landscape of small cell lung cancer (SCLC) has changed since the 2019 and 2020 approvals of anti-PD-L1 atezolizumab and durvalumab for first-line (1L) treatment in combination with chemotherapy. We studied treatment patterns and real-world overall survival (rwOS) following 1L-3L therapy.

Patients and methods: A nationwide electronic health record (EHR)-derived de-identified database was used to describe treatment patterns, characteristics, and survival of patients with extensive-stage (ES)-SCLC by 1L anti-PD-L1 treatment. Patients with ES-SCLC who initiated ≥1 line of systemic therapy from 2013 to 2021, with potential follow-up through 2022, were included.

Results: Among 9952 patients with SCLC, there were 4308 patients with ES-SCLC treated during the study period who met eligibility criteria. Etoposide + platinum (EP) chemotherapy was most common in the 1L, with addition of anti-PD-L1 therapy to most regimens by 2019. Second-line regimens varied by platinum sensitivity status and shifted from topotecan to lurbinectedin over time. Median rwOS following 1L therapy was 8.3 months (95% CI, 7.9-8.8) in those treated with 1L anti-PD-L1 and 8.0 months (95% CI, 7.8-8.2) in those who were not. Following 2L and 3L, median rwOS was 5.6 (95% CI, 4.9-6.3) and 4.9 months (95% CI, 3.4-6.0), respectively, among 1L anti-PD-L1-treated, and 4.5 (95% CI, 4.2-4.9) and 4.0 months (95% CI, 3.7-4.5), respectively, among those who were not.

Conclusion: Despite the introduction of frontline anti-PD-L1 therapy, survival remains dismal among patients with ES-SCLC treated in the real-world setting.

Keywords: immune checkpoint inhibitors; immunotherapy; lung neoplasms; retrospective studies; small cell lung carcinoma; treatment patterns.

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Conflict of interest statement

H.B. reports research support (clinical trials) from BMS, Lilly, and Amgen; advisory board/consultant from BMS, Lilly, Genentech, Pfizer, Merck, EMD-Serono, Boehringer Ingelheim, Astra Zeneca, Novartis, Genmab, Regeneron, BioNTech, Amgen, Axiom, PharmaMar, Takeda, Mirati, Daiichi, Guardant, Natera, Oncocyte, Beigene, iTEO, Jazz, Janssen, Da Volterra, Puma, BerGenBio, Bayer, and Iobiotech; Data and Safety Monitoring Board from University of Pennsylvania: CAR T Program, Takeda, Incyte, Novartis, and Springworks; employment from Fox Chase Cancer Center; Scientific Advisory Board from Sonnetbio (Stock Options), Inspirna (formerly Rgenix, Stock Options), and Nucleai (Stock Options); honoraria from Amgen, Pfizer, Daiichi, and Regeneron; travel from Amgen, BMS, Merck, Lilly, EMD-Serono, Genentech, and Regeneron. J.S., X.P., A.B., E.S.A., T.J., M.P., and P.M. are Amgen employees with stock ownership in Amgen. G.B. is a former employee of Amgen with stock ownership in Amgen. S.S.R.: research support to institution: Amgen, Astra Zeneca, BMS, Merck, Pfizer, and Takeda

Figures

Figure 1.
Figure 1.
Patient attrition. Abbreviations: 1L, first-line; LOT, line of therapy; PD-1, programmed cell death protein 1; PD-L1, programmed death ligand 1; SCLC, small cell lung cancer.
Figure 2.
Figure 2.
Treatment patterns over time by line of therapy in patients with ES-SCLC: (A) first-line treatment, (B) second-line treatment of platinum-resistant patients with CTFI < 90 days, (C) second-line treatment of platinum-sensitive patients with CTFI from 90 to <180 days, (D) second-line treatment of platinum-sensitive patients with CTFI ≥180 days, and (E) third-line treatment. Other immunotherapy includes all other regimens containing an anti-PD-1, anti-PD-L1 or CTLA-4; platinum includes other platinum containing regimens that do not include etoposide; other regimens includes all other regimens that do not fit into any of the other categories. Abbreviations: CTFI, chemotherapy-free interval; ES, extensive-stage; EP, etoposide plus platinum regimen; IO, immunotherapy; anti-PD-L1, anti-programmed death ligand 1; SCLC, small cell lung cancer.
Figure 3.
Figure 3.
Real-world overall survival of patients with ES-SCLC following (A) first-line therapy, (B) second-line therapy, and (C) third-line therapy. Abbreviations: 1L, first-line; 2L, second-line; 3L, third-line; ES-SCLC, extensive-stage small cell lung cancer; rwOS, real-world overall survival.
Figure 4.
Figure 4.
Real-world overall survival of patients with ES-SCLC following (A) first-line therapy stratified by 1L anti-PD-L1 treatment, (B) second-line therapy stratified by 1L anti-PD-L1 treatment, and (C) third-line therapy stratified by 1L anti-PD-L1 treatment. Abbreviations: 1L, first-line; 2L, second-line; 3L, third-line; ES-SCLC, extensive-stage small cell lung cancer; rwOS, real-world overall survival; PD-L1, programmed death ligand 1.
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