Real-World Analysis of Clinical Characteristics and Survival Outcomes in Patients With Extensive-Stage SCLC Treated With First-Line Chemoimmunotherapy

Yang Wang; Jared Mathai; Muhammad Alamgeer; Sagun Parakh; Eldho Paul; Paul Mitchell; Surein Arulananda

doi:10.1016/j.jtocrr.2023.100544

Real-World Analysis of Clinical Characteristics and Survival Outcomes in Patients With Extensive-Stage SCLC Treated With First-Line Chemoimmunotherapy

JTO Clin Res Rep. 2023 Jun 27;4(8):100544. doi: 10.1016/j.jtocrr.2023.100544. eCollection 2023 Aug.

Authors

Yang Wang¹, Jared Mathai², Muhammad Alamgeer¹, Sagun Parakh^{2

3

4}, Eldho Paul⁵, Paul Mitchell^{2

3}, Surein Arulananda^{1

6

7}

Affiliations

¹ Department of Medical Oncology, Monash Health, Clayton, Australia.
² Department of Medical Oncology, Austin Health, Heidelberg, Australia.
³ Olivia Newton-John Cancer Research Institute, Heidelberg, Australia.
⁴ School of Cancer Medicine, La Trobe University, Bundoora, Australia.
⁵ Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
⁶ School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Australia.
⁷ Centre for Cancer Research, Hudson Institute of Medical Research, Clayton, Australia.

Abstract

Introduction: There are no clinically validated prognostic biomarkers in the management of extensive-stage SCLC (ES-SCLC). We explored the association between clinical characteristics and survival outcomes in patients with ES-SCLC treated with chemoimmunotherapy.

Methods: In this retrospective cohort study, patients with ES-SCLC treated with first-line platinum-etoposide chemotherapy and atezolizumab were identified from medical records. Pretreatment clinical characteristics, biochemical parameters, and tumor and treatment characteristics were collected. Univariate and multivariate Cox regression were used to evaluate treatment effect on progression-free survival (PFS) and overall survival (OS).

Results: We evaluated 75 patients in total. The median PFS and OS were 6.1 months and 9.2 months, respectively. Statistically significant associations were found with lower lactate dehydrogenase and improved OS (hazard ratio [HR] = 1.0, 95% confidence interval [CI]: 1.0-1.01, p = 0.006), whereas higher age (HR = 0.94, 95% CI: 0.90-0.98, p = 0.006) and lower neutrophil-to-lymphocyte ratio (HR = 1.08, 95% CI: 1.02-1.14, p = 0.005) were associated with improved PFS. The number of chemotherapy cycles received were associated with both an improved PFS (HR = 0.57, 95% CI: 0.37-0.89, p = 0.011) and OS (HR = 0.5, 95% CI: 0.30-0.84, p = 0.008).

Conclusions: This study highlights the important effect of chemotherapy on survival. Furthermore, the association between lactate dehydrogenase and neutrophil-to-lymphocyte ratio on survival further suggests that baseline tumor burden and optimizing sarcopenia are important factors for clinicians to consider as we seek to develop personalized treatment for this disease.

Keywords: Chemoimmunotherapy; Clinical characteristics; Small cell lung cancer; Survival.