The authors wrote, “The landscape of small cell lung cancer (SCLC) has changed since the 2019 and 2020 approvals of anti-PD-L1 [programmed death ligand-1] atezolizumab and durvalumab for first-line (1L) treatment in combination with chemotherapy.”
The researchers gathered and examined data from a nationwide electronic health record (EHR)–derived deidentified database to describe treatment patterns, characteristics, and survival of patients with ES-SCLC by 1L anti-PD-L1 treatment.
The study cohort comprised patients with ES-SCLC who initiated ≥1 line of systemic therapy from 2013 to 2021, with potential follow-up through 2022. Among 9,952 patients with SCLC who met eligibility criteria during the study period, 4,308 patients with ES-SCLC were treated.
The authors noted that etoposide + platinum (EP) chemotherapy was most common in the 1L, with the addition of anti-PD-L1 therapy to most regimens by 2019. Second-line regimens fluctuated by platinum sensitivity status and transitioned from topotecan to lurbinectedin over time.
The authors wrote, “Among platinum-resistant (CTFI [chemotherapy-free interval] <90 days) patients with ES-SCLC, topotecan was the most common 2L [second line] therapy prior to 2018 (31%) but declined over time, while lurbinectedin use increased from 10% in 2020 to be the most common regimen in 2022 (40%). Similarly, in the platinum-sensitive group in which CTFI was 90-180 days, topotecan was most common in 2L prior to 2018 (36%) but declined over time, while lurbinectedin increased from 24% of 2L regimens in 2020 to be the most common regimen (69%) in 2022.”
The authors added, “Those more sensitive to platinum (with a CTFI ≥180 days) were more commonly treated with EP with or without anti-PD-L1 in the 2L over time until most recently in 2022 when lurbinectedin rose to 54% of regimens.”
The results also indicated that the average rwOS following 1L therapy was 8.3 months among patients treated with 1L anti-PD-L1 and 8.0 months among patients not treated. After 2L and 3L treatments, the average rwOS was 5.6 months and 4.9 months, respectively, for patients treated with first-line anti–PD-L1 therapy. Among patients who did not receive first-line anti-PD-L1 therapy, the average rwOS was 4.5 months and 4.0 months, respectively.
The authors concluded that patient outcomes remain poor despite the advent of anti-PD-L1 therapies for 1L treatment of ES-SCLC; therefore, it is vital to continue research efforts to generate innovative treatment strategies to enhance survival rates for patients diagnosed with ES-SCLC.
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