The results revealed a shifting age distribution toward the age group above 70 years, while the male-to-female ratio gradually evened out and the increasing use of carboplatin over cisplatin and frequent short course radiotherapy, and EP rechallenge was most widespread among those who underwent subsequent therapy.
Abstract
This study provides a comprehensive nationwide analysis of extensive-stage small cell lung cancer (ES-SCLC) in Hungary, examining incidence rates, demographic trends, treatment patterns, and survival outcomes. We used data from the National Health Insurance Fund (NHIF) covering the period of 2013–2022, and we analyzed 8,104 ES-SCLC patients who received first-line (1L) etoposide-platinum (EP) chemotherapy, all of whom were confirmed to not have received concomitant chemoradiotherapy or curative thoracic surgery and had histology results in line with SCLC. We evaluated epidemiology, regional distribution, radiotherapy use, and subsequent treatment pathways. For the efficacy analysis, we narrowed the cohort to 5,576 patients who initiated EP within 1 year of their first C34-coded lung cancer diagnosis between 2013 and 2019, enabling 3-year follow-up. Key endpoints included overall survival (OS) and progression-free survival (PFS), the latter of which was inferred using time to first subsequent therapy (TFST). Our results revealed a shifting age distribution toward the age group above 70 years, while the male-to-female ratio gradually evened out. Treatment patterns showed the increasing use of carboplatin over cisplatin and frequent short course radiotherapy. Among those who underwent subsequent therapy, EP rechallenge was most widespread. Despite high initial response rates, survival outcomes remained poor: median PFS was 6.5 months (6-month: 52.9%, 1-year: 19%, 3-year: 5.2%), and median OS was 9.3 months (6-month: 69.8%, 1-year: 37.5%, 3-year: 9.2%). These results were in line with international real-world evidence and clinical trial data. Our findings highlight the aggressive nature of ES-SCLC and provide insight to the limited efficacy of chemotherapy-based therapies, underscoring the need to improve existing 1L and subsequent-line treatments and to introduce novel options. As Hungary transitions into the immunotherapy era, future studies with extended follow-up that incorporate staging, radiotherapy intent, comorbidities, and progression data will be essential for optimizing therapeutic strategies.
Background Extensive-stage small cell lung cancer (ES-SCLC) is a highly aggressive malignancy with limited treatment options. Immune checkpoint inhibitors (ICIs) have marked the beginning of the immunotherapy era for SCLC. However, population-level survival trends following the introduction of immunotherapy remain unclear. Methods We conducted a retrospective study using Surveillance, Epidemiology, and End Results (SEER) data from 2015 to 2021 to analyze survival outcomes in ES-SCLC patients before (2015–2017) and after (2019–2021) the introduction of ICIs. We employed propensity score matching (PSM) to adjust for confounding factors and used Cox regression models to identify prognostic factors. Kaplan-Meier analysis and log-rank tests were used to assess overall survival (OS) and cancer-specific survival (CSS). Results A total of 7,214 patients were included. After PSM, patients diagnosed in the 2019–2021 cohort demonstrated significantly improved survival compared with those diagnosed in the 2015–2017 cohort. The median overall survival (mOS) improved from 4.0 months [95% confidence interval (CI): 4.0–4.0] in the pre-immunotherapy era to 5.0 months (95% CI: 4.0–5.0) in the post-immunotherapy era [hazard ratio (HR) =0.849, 95% CI: 0.800–0.902; P<0.001], indicating that patients diagnosed during the immunotherapy era experienced better survival than those diagnosed during the pre-immunotherapy era. Marital status, geographical area, and metastasis sites were identified as significant prognostic factors. Notably, brain metastasis did not significantly affect survival, likely due to advancements in treatment. Conclusions Patients diagnosed during the immunotherapy era showed improved survival compared with those diagnosed during the pre-immunotherapy era. Socio-economic and geographical factors also play a critical role in prognosis, suggesting that personalized treatment strategies are essential for optimal patient outcomes.
Yang Li, Can-Hua Liang, Zi-Wei Feng et al.· Journal of Thoracic Disease· 0 citations
Background. Small cell lung cancer (SCLC) accounts for about 15% of all lung cancer cases. It is characterized by aggressive progression, high proliferative capacity, and early hematogenous and lymphogenous dissemination. Although there is a significant baseline sensitivity to first-line chemotherapy, the majority of patients experience disease progression within 6 to 12 months following treatment initiation, with a median overall survival of approximately 12 months.
Aim. To evaluate the efficacy and safety of first-line therapy utilizing atezolizumab combined with carboplatin or cisplatin and etoposide in patients diagnosed with SCLC in a real-world context.
Materials and methods. This retrospective and prospective observational study included 157 patients (119 males and 38 females) aged 32 to 84 years. Compromised performance status (ECOG 2–3) at baseline was observed in 54 patients (34.4%).
Results. The median progression-free survival in patients with SCLC undergoing first-line therapy was 6.18 months (95% confidence interval [CI] 5.69-6.90), while the median overall survival was 10.55 months (95% CI 8.12-13.02). An objective response was recorded in 82 patients (52.3%). Grade 3–4 immune-related adverse events were documented in only 5.1% of the patient population.
Conclusion. The combination of atezolizumab with platinum-based chemotherapy and etoposide as a first-line treatment for SCLC demonstrates high efficacy and an acceptable safety profile in real-world clinical settings.
Julia S. Mansurova, M. Lyadova, E. A. Denisova et al.· Journal of Modern Oncology· 0 citations
OBJECTIVE
For patients with recurrence after chemotherapy for extensive-stage small cell lung cancer (SCLC), the length of the chemotherapy-free interval (CFI) may guide the choice of second-line treatment. However, evidence supporting specific CFI thresholds is limited. We investigated the influence of the CFI on the effectiveness of second-line treatment in SCLC patients.
METHODS
Patients diagnosed with SCLC in 2022 were selected from the Netherlands Cancer Registry. Cox regression and parametric survival models were used to investigate the association between the type of second-line treatment, the CFI, progression-free survival (PFS) and overall survival (OS). Analyses were adjusted for age, sex, performance status, income, comorbidities, response to first-line treatment, and distant metastases.
RESULTS
261 patients were included: 79 received (30.3%) topotecan, 153 (58.6%) platinum rechallenge, and 29 (11.1%) another systemic treatment. Median PFS was 2.0 and 3.9 months after topotecan and platinum rechallenge, respectively. Median OS was 3.8 and 5.6 months, respectively. Multivariable analyses showed a lower risk of progression for patients with a CFI of 90-179 days receiving platinum rechallenge vs topotecan (hazard ratio (HR): 0.62, 95% confidence interval (95%CI): 0.40-0.95), without a difference in OS (HR: 0.99, 95%CI: 0.65-1.52). Parametric survival models confirmed these results.
CONCLUSIONS
For patients with a CFI exceeding 90 days, platinum rechallenge represents a rational second-line treatment strategy. These results remain relevant despite the introduction of first-line chemoimmunotherapy, as a substantial proportion of patients still relapse within 180 days. They are also relevant for healthcare settings where immunotherapy access remains limited or unavailable.
A. Eijkelboom, B. Peters, D. Dumoulin et al.· Lung Cancer· 0 citations
Purpose To describe real-world treatment patterns and outcomes among patients with extensive-stage small cell lung cancer (ES-SCLC) treated with first-line chemotherapy plus durvalumab as in CASPIAN trial within Expanded Access Program, with a focus on the use and impact of consolidation (cRT) and salvage radiotherapy (sRT). Patients and methods This retrospective, multicenter cohort study included patients with ES-SCLC treated with durvalumab plus platinum–etoposide between September 2019 and December 2022 across 11 academic centers in Israel, Poland, Portugal, and Slovenia. Patients characteristics, radiotherapy use, adverse events (AE), and outcomes were collected using a standardized form. Radiotherapy was categorized as cRT, sRT, or palliative RT (pRT). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier methods and compared using log-rank testing. Multivariable Cox regression evaluated predictors of survival. Results A total of 133 patients were included (median age 65 years; 74% ECOG PS 0–1). Radiotherapy was administered to 58.6% of patients (cRT 28.2%, sRT 24.3%, pRT 47.4%). Median (m) PFS and mOS for the entire cohort were 6.9 months (m) and 15.9 m, respectively. Patients receiving cRT achieved the longest mPFS (11.7 m) and a mOS of 19.5 m; sRT was associated with an mOS of 20.4 m. Continuation of durvalumab beyond progression combined with RT was associated with improved survival (p = 0.024). Treatment-related AEs occurred in 38.3% of patients, immune-related toxicities were infrequent, and pneumonitis was rare. Conclusion In this multinational real-world cohort, outcomes with first-line chemo-immunotherapy were consistent with CASPIAN trial. The addition of cRT or sRT appeared feasible, safe, and associated with clinically meaningful survival improvements. Prospective trials are needed to define optimal integration of radiotherapy with chemo-immunotherapy in ES-SCLC.
U. Janžič, W. Shalata, M. Unk et al.· Frontiers in Oncology· 0 citations
Purpose
Chemoimmunotherapy has improved outcomes in extensive-stage small-cell lung cancer (ES-SCLC), but its benefit in older adults remains uncertain because this population is underrepresented in clinical trials. We evaluated the real-world efficacy of first-line atezolizumab plus etoposide-carboplatin according to age in patients with ES-SCLC.
Materials and Methods
We conducted a multicenter retrospective study across seven Korean institutions and identified patients with ES-SCLC treated between 2016 and 2022 with atezolizumab plus etoposide-carboplatin or etoposide-platinum chemotherapy alone. Patients with recurrence after prior limited-stage disease or incomplete records were excluded. End points were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), assessed using Kaplan-Meier methods and Cox regression models.
Results
Among 550 identified patients, 538 were included: 247 received atezolizumab plus chemotherapy and 291 received chemotherapy alone. Overall, 111 patients (20.2%) were aged 75-80 and 57 (10.4%) were older than 80years. In the overall population, atezolizumab was associated with improved PFS (hazard ratio [HR], 0.78; 95% CI, 0.65 to 0.93; p=0.006) and OS (HR, 0.76; 95% CI, 0.63 to 0.93; p=0.006). Age-stratified analyses showed significant PFS benefit only in patients aged 70-75 (HR, 0.67; p=0.049) and significant OS benefit only in patients aged 65-70 (HR, 0.65; p=0.044). Beyond 75 years, neither PFS nor OS was significantly improved. Patients aged ≥75years also had lower ORR and more progressive or non-evaluable disease compared with <75years.
Conclusion
The clinical benefit of adding atezolizumab appears attenuated in ES-SCLC patients age 75 years or older, supporting careful selection and age-adapted treatment strategies.
Yun-Gyoo Lee, Tae-Hwan Kim, Du-Young Kang et al.· Cancer research and treatmen...· 0 citations
Background and Aims: Despite the evolution in management of metastatic human epidermal growth factor receptor-2 gastric cancer over the past decade, challenges remain in accessing new therapies in some parts of the world. We aimed to describe real-world treatment patterns, attrition, and survival outcomes in patients with human epidermal growth factor receptor 2-positive metastatic gastric cancer. Materials and Methods: This retrospective cohort study included patients aged ≥ 18 years with human epidermal growth factor receptor 2-positive metastatic gastric cancer who received at least one line of systemic antineoplastic therapy between January 1, 2015, and December 30, 2024. The primary outcome of the study was to define treatment choices and attrition rates in real-world clinical practice. Secondary endpoints were progression-free survival across treatment lines and overall survival. Results: Thirty-nine patients were included; median age was 65.5 years (min - max, 24.2 - 82.9), and 74.4% were male. The most common first-line regimens were oxaliplatin + 5-fluorouracil plus trastuzumab (38.5%) and docetaxel + cisplatin + 5-fluorouracil plus trastuzumab (25.6%); 15.4% did not receive trastuzumab, and no patient received pembrolizumab as first-line treatment. Median first-line progression-free survival was 7.49 months (95% CI 5.56 - 9.42), and median overall survival was 16.53 months (95% CI 12.56 - 20.49). Overall, 68.4% of patients received second-line therapy, 41.0% received third-line therapy, and 10.3% proceeded to fourth-line treatment. Second-line treatment was predominantly irinotecan + 5-fluorouracil-based, while paclitaxel was the most frequent third-line regimen. Median progression-free survival was 3.35 months (95% CI 3.02 - 3.68) in the second line and 2.69 months (95% CI 2.28 - 3.10) in the third-line setting. Disease progression was the leading cause of treatment discontinuation across all lines. Conclusion: Human epidermal growth factor receptor-2-positive metastatic gastric cancer remains associated with poor survival and limited real-world access to novel agents. There is an ongoing need for more effective therapies and better implementation of new treatments in routine practice.
Hatice Bölek· Akademik Gastroenteroloji De...· 0 citations
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