2499 - Real-World Study on the Efficacy, Safety, and Prognostic Analysis of Chemotherapy Combined with Immunotherapy as First-Line Treatment for Extensive Stage Small Cell Lung Cancer
Presenter(s)
Q. Li1, Q. Liu2, J. Wang3, J. Wang4, and B. Li5; 1The Fourth Hospital of Hebei Medical University, Shijiazhuang, He Bei, China, 2Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 3the Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 4Fourth Hospital of Hebei Medical University, Shijiazhuang, China, 5The Fourth Hospital of Hebei Medical University, Shi Jia Zhuang, China
Purpose/Objective(s): Chemotherapy combined with immunotherapy has become the first-line standard treatment for extensive-stage small-cell lung cancer (ES-SCLC). This study aims to evaluate the efficacy, safety, and prognostic factors associated with this first-line treatment approach in a real-world clinical setting.
Materials/Methods: This retrospective study included 163 patients with ES-SCLC who received first-line chemotherapy combined with immunotherapy at our center from September 2019 to June 2023.Clinical characteristics, treatment outcomes, and adverse events were assessed to identify prognostic risk factors and evaluate the efficacy and safety of the combination treatment.
Results: A total of 163 patients with ES-SCLC were included, with a median follow-up time of 29.87 months. The overall objective response rate (ORR) for first-line treatment was 69.9%, and the disease control rate (DCR) was 70.6%. The median progression-free survival (PFS) was 7.83 months, and the median overall survival (OS) was 16.63 months. Univariate Cox regression analysis identified baseline liver metastasis and radiotherapy as factors associated with OS, with multivariate analysis showing liver metastasis as an independent prognostic factor. Subgroup analysis revealed that adding radiotherapy to first-line treatment significantly improved OS (21.03 months vs. 13.87 months, p = 0.012), especially with thoracic radiotherapy and prophylactic cranial irradiation. No significant difference in median PFS was observed between patients who received anti-angiogenic therapy and those who did not (8.07 months vs. 7.70 months, p = 0.363). However, patients who did not receive anti-angiogenic therapy had a longer median OS (17.57 months vs. 13.30 months, p = 0.890). Notably, patients receiving anti-angiogenic therapy in second or third-line treatment showed benefits in both PFS and OS. In terms of safety, the overall incidence of adverse reactions was 93.25%, with 15.95% experiencing grade ¡Ý3 adverse reactions. Both radiotherapy and anti-angiogenic therapy combinations were associated with higher rates of overall and grade ¡Ý3 adverse reactions, though no treatment-related deaths occurred.
Conclusion: First-line chemotherapy combined with immunotherapy demonstrates effective outcomes for ES-SCLC in real-world practice. Liver metastasis at baseline may serve as a negative prognostic factor for OS, while incorporating radiotherapy or anti-angiogenic therapy could improve survival with manageable toxicity.