Abstract
The prognosis for extensive-stage small cell lung cancer (ES-SCLC) is poor. Real-world evidence can highlight the unmet clinical need within this population. We conducted a population-based cohort study of ES-SCLC patients diagnosed in a large Canadian province (2010–2018) using electronic medical records and administrative claims data. In all, 1941 ES-SCLC patients were included, of which 476 (25%) were recurrent cases. Median age at diagnosis was 70 years (range: 39–94) and 50.2% were men. Of the 1941 ES-SCLC patients, 29.5% received chemotherapy and radiotherapy, 17.0% chemotherapy alone, 8.7% radiotherapy alone, and 44.8% received best supportive care. Chemotherapy was initiated by 46.5%, 8.5%, and 1.4% of first-, second-, and third-line patients, with lower uptake for recurrent cases. Median survival from first-, second-, and third-line chemotherapy was 7.82 months (95% CI: 7.50–8.22), 5.72 months (95% CI: 4.90–6.87), and 3.83 months (95% CI: 2.99–4.60). Among patients who received first-line therapy, the 2-year and 5-year survival was 7.3% (95% CI: 5.7–9.2) and 2.9% (95% CI: 1.8–4.5). In conclusion, initiation of first-line treatment in ES-SCLC was low with significant attrition in subsequent lines. These results underscore the need for effective front-line treatments and highlight the potential for novel therapies to improve patient outcomes.
Highlights
Lung cancer is the second most common type of cancer among both men and women in Canada, and small cell lung cancer (SCLC) accounts for approximately 12% of lung cancer cases [1]
A total of 1941 extensive-stage small cell lung cancer (ES-SCLC) patients were included in this study, with 1465 (75%) patients diagnosed with de novo ES-SCLC and 476 (25%) patients who initially presented with
Relative to patients who initiated chemotherapy, patients who did not initiate chemotherapy were significantly older (p < 0.001; standardized mean differences (SMD) = 0.469); had more comorbidities (p < 0.001; SMD = 0.306), including chronic pulmonary disease (p = 0.004; SMD = 0.153), cardiovascular disease (p < 0.001; SMD = 0.209), and renal disease (p < 0.003; SMD = 0.160); had worse performance status based on proxy measures; and were less likely to have metastases to the lymph nodes (p = 0.034; SMD = 0.116) but more likely to have metastases to the pleura (p = 0.001; SMD = 0.186) or bone marrow (p = 0.048; SMD = 0.111)
Summary
Lung cancer is the second most common type of cancer among both men and women in Canada, and small cell lung cancer (SCLC) accounts for approximately 12% of lung cancer cases [1]. SCLC is considered to be a very aggressive cancer that is often diagnosed late and has a high rate of recurrence and low survival [2]. SCLC is classified as either limited-stage (LS), where the cancer is contained to one side of the chest, or extensivestage (ES), where the cancer has spread to tissue outside of the originally affected lung [2]. SCLC can be staged using the American Joint. First-line treatment for SCLC is often a platinum-based chemotherapy (cisplatin or carboplatin) in combination with etoposide, and radiation is considered for some patients [2]
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