Long-term outcome of chemoimmunotherapy for extensive-stage small-cell lung cancer according to key clinical trial eligibility: 3-year outcomes from a prospective cohort study

Jun Sugisaka; Daichi Fujimoto; Motohiro Tamiya; Akito Hata; Hirotaka Matsumoto; Toshihide Yokoyama; Yoshihiko Taniguchi; Junji Uchida; Yuki Sato; Takashi Kijima; Hisashi Tanaka; Naoki Furuya; Takeshi Masuda; Yoshihiko Sakata; Eisaku Miyauchi; Go Saito; Satoru Miura; Teppei Yamaguchi; Haruko Daga; Shinya Sakata; Nobuyuki Yamamoto; Hiroaki Akamatsu

doi:10.1016/j.lungcan.2024.108056

Long-term outcome of chemoimmunotherapy for extensive-stage small-cell lung cancer according to key clinical trial eligibility: 3-year outcomes from a prospective cohort study

Lung Cancer. 2024 Dec 9:199:108056. doi: 10.1016/j.lungcan.2024.108056. Online ahead of print.

Authors

Jun Sugisaka¹, Daichi Fujimoto², Motohiro Tamiya³, Akito Hata⁴, Hirotaka Matsumoto⁵, Toshihide Yokoyama⁶, Yoshihiko Taniguchi⁷, Junji Uchida⁸, Yuki Sato⁹, Takashi Kijima¹⁰, Hisashi Tanaka¹¹, Naoki Furuya¹², Takeshi Masuda¹³, Yoshihiko Sakata¹⁴, Eisaku Miyauchi¹⁵, Go Saito¹⁶, Satoru Miura¹⁷, Teppei Yamaguchi¹⁸, Haruko Daga¹⁹, Shinya Sakata²⁰, Nobuyuki Yamamoto²¹, Hiroaki Akamatsu²¹

Affiliations

¹ Department of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan. Electronic address: [email protected].
² Department of Respiratory Medicine and Hematology, Hyogo Medical University, Nishinomiya, Japan; Internal Medicine III, Wakayama Medical University, Wakayama, Japan.
³ Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan.
⁴ Division of Thoracic Oncology, Kobe Minimally Invasive Cancer Center, Kobe, Japan.
⁵ Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
⁶ Department of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
⁷ Department of Internal Medicine, NHO Kinki Chuo Chest Medical Center, Sakai, Japan.
⁸ Department of Respiratory Medicine, Osaka General Medical Center, Osaka, Japan.
⁹ Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁰ Department of Respiratory Medicine and Hematology, Hyogo Medical University, Nishinomiya, Japan.
¹¹ Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan.
¹² Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
¹³ Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan.
¹⁴ Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
¹⁵ Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁶ Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan.
¹⁷ Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan.
¹⁸ Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
¹⁹ Department of Clinical Oncology, Osaka City General Hospital, Osaka, Japan.
²⁰ Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan.
²¹ Internal Medicine III, Wakayama Medical University, Wakayama, Japan.

PMID: 39674045
DOI: 10.1016/j.lungcan.2024.108056

Abstract

Background: Chemoimmunotherapy is the standard first-line treatment for extensive-stage small-cell lung cancer (ES-SCLC); however, its real-world long-term outcomes associated with patient backgrounds are still unclear. We explored this association using an updated large real-world prospective cohort with a minimum follow-up of 3 years.

Methods: This prospective cohort study, conducted across 32 hospitals, enrolled patients with ES-SCLC receiving carboplatin, etoposide, and atezolizumab between September 1, 2019 and September 30, 2020. Updated data with a minimum 3-year follow-up period were analyzed. Patients who met eligibility criteria for pivotal phase 3 clinical trials were considered "trial-eligible."

Results: The median (range) time from the treatment initiation to data cutoff (September 30, 2023) was 42.2 (35.8-48.2) months for the enrolled 207 patients. Most patients (89 %) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients fulfilling the inclusion criteria (132 [64 %]) were categorized as trial-eligible. The 3-year progression-free survival (PFS) probability and overall survival (OS) were 6.1 % and 20.9 %, respectively. The 3-year OS probabilities for trial-eligible and trial-ineligible patients were 26.7 and 9.5 %, respectively. The trial-eligible cohort had a larger percentage of patients achieving a 3-year OS (30/132, 22.7 %) than the trial-ineligible cohort (5/75, 6.7 %) (P = 0.003) CONCLUSIONS: Our study provides the first documentation of the long-term outcomes following chemoimmunotherapy in a large prospective real-world cohort of patients with ES-SCLC. Key eligibility criteria significantly influenced the long-term effectiveness. These findings provide valuable insights into the practical effectiveness of chemoimmunotherapy and clinical decision-making for patients with ES-SCLC.

Keywords: Anti-programmed death ligand 1; Chemoimmunotherapy; Eligibility criteria; Extensive-stage small-cell lung carcinoma; Immune checkpoint inhibitors; Long-term outcome; Prospective study.