1543P A retrospective cross-sectional study of treatment patterns in small cell lung cancer (SCLC) in Europe 2018–2021

Abstract

SCLC is an aggressive neuroendocrine malignancy with poor prognosis. Development of new effective treatments was limited until the emergence of immune checkpoint inhibitors. The anti-PD-L1 therapies, atezolizumab and durvalumab, received EU approval for 1st-line (1L) treatment of extensive stage SCLC (ES-SCLC) in 2019 and 2020, respectively. To better characterise the emerging treatment landscape, we investigated SCLC treatment patterns in France, Germany, Spain, Italy and the UK. The study included all adults aged ≥18 years who were diagnosed with ES-SCLC and received any systemic treatments between Q1 2018 and Q4 2021 from a representative, retrospective oncology database. Baseline characteristics and treatment regimens by year, line of therapy, and platinum-sensitivity status were described. Of 5832 eligible patients (1L=4898, 2L=804, 3L+=130), 3843 were male (65.9%), with a median age of 66 years. Most patients were diagnosed with stage IV disease (88.4%). The most common 1L regimens over 2018–2021 were platinum + etoposide combination chemotherapies (91.8%, 86.0%, 62.9%, 42.3%, respectively; Table). Use of a platinum-based regimen + atezolizumab increased from 2019 to 2021 (5.6%, 27.3%, 40.0%, respectively). In 2021, platinum + atezolizumab was the most common 1L regimen in Germany (54.8%), France (46.2%) and the UK (43.7%). In France, platinum + durvalumab was the second most common therapy in 2021, accounting for 30.3% of 1L regimens, but this combination was uncommon in Germany (2.7%), Spain (2.0%), the UK (0.4%) and Italy (0.3%). Uptake of immune checkpoint inhibitor use was also observed in 2L treatment between 2019–2021 (3.8%, 4.9%, 11.0%, respectively), equally distributed for both platinum-resistant and platinum-sensitive patients.Table: 1543PRegimens by year in 1L ES-SCLC in EuropeRegimen2018 (n=1176)2019 (n=1190)2020 (n=1329)2021 (n=1203)Platinum1 + etoposide1079 (91.7)1023 (86.0)835 (62.8)509 (42.3)Platinum mono30 (2.6)49 (4.1)43 (3.2)49 (4.1)Platinum1 + atezolizumab067 (5.6)363 (27.3)481 (40.0)Platinum1 + durvalumab006 (0.5)53 (4.4)Anti-PD-(L)1/anti-CTLA-4 mono or combo22 (0.2)8 (0.7)32 (2.4)63 (5.2)Etoposide mono18 (1.5)11 (0.9)9 (0.7)8 (0.7)Other347 (4.0)32 (2.7)41 (3.1)40 (3.3)Data are n (%). 1Platinum-based chemo. 2Includes atezolizumab, durvalumab, nivolumab, pembrolizumab, tremelimumab, ipilimumab. 3Includes platinum combos, non-platinum-based chemo, and other non-chemo treatments Open table in a new tab Data are n (%). 1Platinum-based chemo. 2Includes atezolizumab, durvalumab, nivolumab, pembrolizumab, tremelimumab, ipilimumab. 3Includes platinum combos, non-platinum-based chemo, and other non-chemo treatments Since approval, use of anti-PD-L1 inhibitor combination therapy as a 1L treatment of ES-SCLC in Europe increased, although the speed of uptake varied between countries.