Oncology Department, University Hospital of Geneva, Geneva, Switzerland.
Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
Clin Lung Cancer. 2020 Nov;21(6):e539-e543. doi: 10.1016/j.cllc.2020.04.006. Epub 2020 Apr 30.
After decades of platinum-based chemotherapy for advanced small-cell lung cancer, there has finally been a therapeutic advance. The combination of a platinum chemotherapy, etoposide, and an immune checkpoint inhibitor has yielded overall survival benefits in two successive phase 3 trials. Unfortunately, these trials only included fit patients, namely those with an Eastern Cooperative Oncology Group performance status of 0-1. In the real-world setting, roughly a third of patients with advanced small-cell lung cancer has a performance status of 2, and an additional 15% have a performance status of 3 or 4, meaning that approximately half of all patients are excluded from chemoimmunotherapy trials. Poor performance status is a known negative prognostic factor, with a dismal prognosis among patients with disease that does not respond to the first cycle of chemotherapy.We review current data on immunotherapy in advanced small-cell lung cancer and discuss how we integrate the new therapeutic options into daily practice.
在经过几十年的铂类化疗治疗晚期小细胞肺癌之后，终于取得了治疗上的进展。铂类化疗药物依托泊苷联合免疫检查点抑制剂的治疗方案在两项连续的 3 期临床试验中均带来了总生存期的获益。不幸的是，这些试验仅纳入了一般状况良好的患者，即东部肿瘤协作组体力状况评分为 0-1 的患者。在真实世界的环境中，大约三分之一的晚期小细胞肺癌患者的体力状况评分为 2，另外 15%的患者的体力状况评分为 3 或 4，这意味着大约一半的患者被排除在化疗免疫治疗试验之外。体力状况差是一个已知的预后不良因素，对于化疗第一周期无反应的患者，预后极差。我们回顾了晚期小细胞肺癌免疫治疗的现有数据，并讨论了如何将新的治疗选择整合到日常实践中。
