Abstract
In this observational study, we assessed treatment patterns and prognostic factors in patients with small cell lung cancer (SCLC) in a large state-mandated healthcare organization in Israel. Methods: All incident cases with histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 and 2017 were identified. Treatment patterns and overall survival (OS) were evaluated for each line of therapy. Results: A total of 235 patients were identified (61% male, median age 64 years, 95% ever smokers, 64% had extensive stage). The first-line treatment was platinum–etoposide regimen for 98.7% of the cohort. The second and third-line regimen were given to 43% and 12% of patients, respectively. Mean OS for extensive and limited stage patients was 9.1 and 23.5 months respectively. In a multivariable model, increased risk for mortality was observed among patients with an ECOG performance status (PS) of 2 compared to a PS of 0–1 for the extensive stage patients (Hazard ratio (HR) = 1.63, 95% confidence ratios (CI): 1.00–2.65); and for males compared to females for the limited stage patients (HR = 2.17; 95% CI: 1.12–4.20). Regarding all 2nd line patients in a multivariable model incorporating relevant confounding factors, demonstrated a significantly better outcome with platinum–based regimens compared to topotecan. Median survival after initiation of 2nd line in platinum-sensitive patients was longer (p = 0.056) for those re-challenged with platinum–based regimen (n = 7): 6.8mo (6.1-not reported (NR)), compared with those switched to a different treatment (n = 27): 4.5 mo (2.6–6.6) for extensive stage patients, and a non-significant difference was also observed for limited stage patients. Conclusion: To our knowledge, this is one of the largest real-world studies of SCLC patients. OS for SCLC patients was similar to that reported in clinical trials. PS for extensive stage patients and sex for limited stage patients were significant correlates of prognosis. Re-challenge of the platinum–based doublet was associated with longer OS compared to switching treatment in extensive stage patients.
Highlights
Small cell lung cancer (SCLC) is an aggressive smoking-associated malignancy with rapid growth and early metastatic dissemination [1] that accounts for 10% to 15% of all diagnoses of lung cancers [2,3,4,5,6].Almost two-thirds of SCLC patients have extensive stage disease at presentation, with a median survival of 7 to 11 months and only 1% being alive at 5 years [7,8,9].Patients with limited stage disease are treated with concurrent chemotherapy and chest irradiation, whereas extensive stage patients are traditionally treated with chemotherapy alone
We found when limiting the analysis to platinum-sensitive patients, those re-treated with platinum–based chemotherapy had a longer numerical survival than those switched to treatment with topotecan single agent for both extensive and limited stage, but did not reach statistical significance, similar to a previously published study [31]
overall survival (OS) for SCLC patients in a real-world setting was found to be similar to those reported in clinical trials
Summary
Small cell lung cancer (SCLC) is an aggressive smoking-associated malignancy with rapid growth and early metastatic dissemination [1] that accounts for 10% to 15% of all diagnoses of lung cancers [2,3,4,5,6].Almost two-thirds of SCLC patients have extensive stage disease at presentation, with a median survival of 7 to 11 months and only 1% being alive at 5 years [7,8,9].Patients with limited stage disease are treated with concurrent chemotherapy and chest irradiation, whereas extensive stage patients are traditionally treated with chemotherapy alone. First-line (L1) chemotherapy with cisplatin or carboplatin with etoposide has been the standard of care for several decades [10], with no changes besides the recent incorporation of atezolizumab to platinum–based regimen in patients with extensive stage disease [11,12,13,14]. Prophylactic brain irradiation mostly for responding patients with limited disease was part of the standard of care [15,16] but has recently been challenged [17]. Despite high sensitivity to initial chemotherapy and radiotherapy, most patients with either limited or extensive tumors relapse relatively early [20,21] and cure rates remain low [22]
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