Real-world treatment patterns and survival in extensive stage small-cell lung cancer in Japan

Objective: To describe standard of care and inform the evolving unmet need among extensive stage small-cell lung cancer (ES-SCLC) patients in Japan since approval of first-line anti-PD-L1 therapies, we describe treatment patterns and overall survival by line of therapy.

Methods: We conducted a descriptive analysis of adult ES-SCLC patients in Japan using de-identified patient data within the MDV database (hospital-based claims) to describe treatment patterns and DeSC database (payer-based claims linked to mortality of municipality records) to describe both treatment patterns and real-world overall survival (rwOS).

Results: The study population of MDV and DeSC cohorts included 6302 and 903 patients, respectively. First-line anti-PD-L1 therapy-based regimens grew since their approval in 2019 and were used in ~35% and ~59% of patients in 2022, in the MDV and DeSC cohorts, respectively. Amrubicin monotherapy was the most common second-line (2 L) regimen before and after 1 L anti-PD-L1 approvals. No clear standard of care was identified in third-line (3 L) and fourth-line (4 L). Median rwOS following 1 L therapy was 10.6 months (95% CI: 9.0, 11.8) and 9.3 months (95% CI: 8.3, 10.3) in patients who did and did not receive anti-PD-L1 therapy, respectively. Following 2 L, 3 L, and 4 L therapy, median rwOS was 6.7 months (95% CI: 5.9, 7.4), 5.5 months (95% CI: 4.4, 6.4), and 4.7 months (95% CI: 3.4, 6.9), respectively.

Conclusions: Anti-PD-L1 therapies have become part of first-line standard of care but survival in treated Japanese ES-SCLC patients remains poor, highlighting the unmet medical need in the post anti-PD-L1 era.