Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer
Abstract Background The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival rate in patients with extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy remains controversial. This study aime...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02308-2 |
| _version_ | 1797784505341181952 |
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| author | Jianfeng Peng Lemeng Zhang Liping Wang Hui Feng Dongmei Yao Rui Meng Xiaomei Liu Xiaohua Li Ningbo Liu Bingxu Tan Zhaoqin Huang Shanshan Li Xiangjiao Meng |
| author_facet | Jianfeng Peng Lemeng Zhang Liping Wang Hui Feng Dongmei Yao Rui Meng Xiaomei Liu Xiaohua Li Ningbo Liu Bingxu Tan Zhaoqin Huang Shanshan Li Xiangjiao Meng |
| author_sort | Jianfeng Peng |
| collection | DOAJ |
| description | Abstract Background The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival rate in patients with extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy remains controversial. This study aimed to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy. Methods The patients who received durvalumab or atezolizumab combined with chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were enrolled. They were divided into two groups, based on whether they received TRT or not. Propensity score matching (PSM) with a 1:1 ratio was performed. The primary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Results A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 57 pairs of patients were enrolled in the analysis. In all patients, the median PFS (mPFS) in the TRT and non-TRT group was 9.5 and 7.2 months, respectively, with HR = 0.59 (95%CI 0.39–0.88, p = 0.009). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95%CI 0.31–0.89, p = 0.016). Multivariable analysis showed that baseline liver metastasis and the number of metastases ≥ 3 were independent prognostic factors for OS. Addition of TRT increased the incidence of treatment-related pneumonia (p = 0.018), most of which were grade 1–2. Conclusions Addition of TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. Although it may leads to increased incidence of treatment-related pneumonia, a majority of the cases can be relieved after symptomatic treatment. |
| first_indexed | 2024-03-13T00:40:52Z |
| format | Article |
| id | doaj.art-a73b69be6b0e46688ceb02b6fe9f4456 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-13T00:40:52Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-a73b69be6b0e46688ceb02b6fe9f44562023-07-09T11:20:19ZengBMCRadiation Oncology1748-717X2023-07-0118111210.1186/s13014-023-02308-2Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancerJianfeng Peng0Lemeng Zhang1Liping Wang2Hui Feng3Dongmei Yao4Rui Meng5Xiaomei Liu6Xiaohua Li7Ningbo Liu8Bingxu Tan9Zhaoqin Huang10Shanshan Li11Xiangjiao Meng12Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesDepartment of Thoracic Department, Hunan Cancer HospitalDepartment of Medical Oncology, Baotou Cancer HospitalDepartment of Clinical Oncolygy, The Affiliated Hospital of Qingdao UniversityDepartment of Medical Oncology, Chaoyang Second HospitalDepartment of Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of Oncology Department, Jinzhou Medical UniversityDepartment of Respiratory and Critical Care, Chifeng Municipal HospitalDepartment of Radiation Oncology, Tianjin Medical University Cancer Institute & HospitalDepartment of Radiation Oncology, Qilu Hospital of Shandong UniversityDepartment of Radiology, Shandong Provincial HospitalDepartment of Oncology, Zibo Municipal HospitalDepartment of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical SciencesAbstract Background The CREST study showed that the addition of thoracic radiotherapy (TRT) could improve the survival rate in patients with extensive stage small cell lung cancer (ES-SCLC), but whether TRT can bring survival benefit in the era of immunotherapy remains controversial. This study aimed to explore the efficacy and safety of adding TRT to the combination of PD-L1 inhibitors and chemotherapy. Methods The patients who received durvalumab or atezolizumab combined with chemotherapy as the first-line treatment of ES-SCLC from January 2019 to December 2021 were enrolled. They were divided into two groups, based on whether they received TRT or not. Propensity score matching (PSM) with a 1:1 ratio was performed. The primary endpoints were progression-free survival (PFS), overall survival (OS) and safety. Results A total of 211 patients with ES-SCLC were enrolled, of whom 70 (33.2%) patients received standard therapy plus TRT as first-line treatment, and 141 (66.8%) patients in the control group received PD-L1 inhibitors plus chemotherapy. After PSM, a total of 57 pairs of patients were enrolled in the analysis. In all patients, the median PFS (mPFS) in the TRT and non-TRT group was 9.5 and 7.2 months, respectively, with HR = 0.59 (95%CI 0.39–0.88, p = 0.009). The median OS (mOS) in the TRT group was also significantly longer than that in the non-TRT group (24.1 months vs. 18.5 months, HR = 0.53, 95%CI 0.31–0.89, p = 0.016). Multivariable analysis showed that baseline liver metastasis and the number of metastases ≥ 3 were independent prognostic factors for OS. Addition of TRT increased the incidence of treatment-related pneumonia (p = 0.018), most of which were grade 1–2. Conclusions Addition of TRT to durvalumab or atezolizumab plus chemotherapy significantly improves survival in ES-SCLC. Although it may leads to increased incidence of treatment-related pneumonia, a majority of the cases can be relieved after symptomatic treatment.https://doi.org/10.1186/s13014-023-02308-2Extensive stage small cell lung cancerPD-L1 inhibitorsThoracic radiotherapySurvivalToxicity |
| spellingShingle | Jianfeng Peng Lemeng Zhang Liping Wang Hui Feng Dongmei Yao Rui Meng Xiaomei Liu Xiaohua Li Ningbo Liu Bingxu Tan Zhaoqin Huang Shanshan Li Xiangjiao Meng Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer Radiation Oncology Extensive stage small cell lung cancer PD-L1 inhibitors Thoracic radiotherapy Survival Toxicity |
| title | Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer |
| title_full | Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer |
| title_fullStr | Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer |
| title_full_unstemmed | Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer |
| title_short | Real-world outcomes of PD-L1 inhibitors combined with thoracic radiotherapy in the first-line treatment of extensive stage small cell lung cancer |
| title_sort | real world outcomes of pd l1 inhibitors combined with thoracic radiotherapy in the first line treatment of extensive stage small cell lung cancer |
| topic | Extensive stage small cell lung cancer PD-L1 inhibitors Thoracic radiotherapy Survival Toxicity |
| url | https://doi.org/10.1186/s13014-023-02308-2 |
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