Graduate School, Beijing University of Chinese Medicine, Beijing, China.
Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China.
Front Immunol. 2022 Nov 30;13:1059331. doi: 10.3389/fimmu.2022.1059331. eCollection 2022.
Extensive-stage small-cell lung cancer (ES-SCLC) is highly malignant, is highly prone to recurrence, and has a short survival period. It is very difficult to achieve long-term survival in ES-SCLC, which has not been significantly improved in the last 20 years. For a long time, platinum-based chemotherapy has occupied the core position in the treatment of small-cell lung cancer (SCLC), but there are few options for treatment drugs or regimens, and if disease progression occurs, the options for follow-up regimens are obviously limited. The advent of immunotherapy has changed this situation to some extent, and immunotherapy has shown some effects in improving efficiency and prolonging survival, whether in first- or third-line therapy, but it is still unsatisfactory.
A 57-year-old patient with ES-SCLC experienced disease progression after four lines of treatment including synchronous radiotherapy, chemotherapy, and antiangiogenesis. However, the patient still benefited when switching to the programmed cell death receptor-1 (PD-1) inhibitor toripalimab in combination with chemotherapy in the fifth line. Even after the development of immune resistance, the patient still benefited after switching to tislelizumab in combination with different chemotherapy regimens or alone in the sixth and seventh lines. Following the progression of tislelizumab in combination with chemotherapy, the patient again profited after switching to durvalumab in combination with anlotinib and again achieved a progressive-free survival (PFS) of 11 months. Overall, the patient achieved a total of 45 months of PFS and 50 months of overall survival (OS), with a shocking and exciting 30 months of PFS achieved in the immune combination phase alone.
We report a patient with ES-SCLC who achieved long-term survival after at least eight lines of therapy including chemotherapy, antiangiogenesis, and different immune checkpoint inhibitors (ICIs). This suggests that long-term survival in SCLC is possible with aggressive, combined, and standardized treatment. Otherwise, immunotherapy postline enablement can still benefit patients, rechallenge after immune resistance is also possible in SCLC, and combination with chemotherapy or antiangiogenic therapy can improve the efficacy and prolong the survival. This will provide new ideas and options for the selection of treatment options for SCLC.
广泛期小细胞肺癌（ES-SCLC）恶性程度高，易复发，生存时间短。在过去的 20 年中，ES-SCLC 的长期生存并未得到显著改善，这一情况非常棘手。长期以来，铂类为基础的化疗在小细胞肺癌（SCLC）的治疗中占据核心地位，但治疗药物或方案选择有限，如果疾病进展，后续方案的选择明显受限。免疫疗法的出现在一定程度上改变了这种情况，免疫疗法在提高疗效和延长生存方面显示出了一定的效果，无论是一线还是三线治疗，但仍不尽如人意。
一名 57 岁的 ES-SCLC 患者在经历了同步放化疗和抗血管生成治疗等四线治疗后出现疾病进展，但在第五线改用程序性细胞死亡受体-1（PD-1）抑制剂替雷利珠单抗联合化疗时仍获益。即使出现免疫耐药，在第六线和第七线改用替雷利珠单抗联合不同化疗方案或单药治疗时仍获益。在替雷利珠单抗联合化疗进展后，再次改用度伐利尤单抗联合安罗替尼时患者再次获益，并再次获得 11 个月的无进展生存期（PFS）。总体而言，患者共获得 45 个月的 PFS 和 50 个月的总生存期（OS），单独免疫联合治疗阶段就获得了令人震惊和激动人心的 30 个月 PFS。
我们报告了一名 ES-SCLC 患者，该患者在接受至少包括化疗、抗血管生成和不同免疫检查点抑制剂（ICI）在内的八种以上治疗方案后实现了长期生存。这表明，通过积极、联合和规范化治疗，SCLC 是有可能实现长期生存的。否则，免疫治疗后线启用仍能使患者受益，SCLC 发生免疫耐药后再次挑战也是可能的，联合化疗或抗血管生成治疗可以提高疗效并延长生存时间。这将为 SCLC 的治疗方案选择提供新的思路和选择。
