Department of Internal Medicine, Mayo Clinic, Phoenix, Arizona, USA.
Division of Hematology-Oncology, Mayo Clinic Cancer Center, Phoenix, Arizona, USA.
Cancer. 2023 Nov 15;129(22):3546-3553. doi: 10.1002/cncr.34966. Epub 2023 Aug 7.
Immune checkpoint inhibitor combined with platinum-etoposide is the standard first-line therapy for patients with extensive-stage small cell lung cancer (ES-SCLC). The phase 3 clinical trials that led to the approval of chemoimmunotherapy in ES-SCLC excluded patients who had an Eastern Cooperative Group (ECOG) performance status (PS) of 2-3. Therefore, data on the efficacy of chemoimmunotherapy in patients with an ECOG PS of 2-3 are limited.
A retrospective analysis was performed on patients diagnosed with ES-SCLC who received chemoimmunotherapy (atezolizumab or durvalumab) within the Mayo Clinic Health System between January 2016 and January 2021. The objective of this study was to compare the overall survival (OS), progression-free survival (PFS), and best clinical response to therapy in patients with an ECOG PS of 0-1 vs. patients with an ECOG PS of 2-3 who received chemoimmunotherapy for newly diagnosed ES-SCLC.
In total, 82 patients were included in the study. The mean ± standard deviation age was 68.1 ± 8.3 years. Of these, 56 patients were identified with an ECOG PS of 0-1, and 26 patients were identified with an ECOG PS of 2-3. The median PFS was similar regardless of ECOG PS (5.8 months [95% CI, 4.3-6.0 months] in the ECOG PS 0-1 group vs. 4.1 months [95% CI, 3.8-6.9 months] in the ECOG PS 2-3; p = .2994). The median OS was also similar regardless of ECOG PS (10.6 months [95% CI, 8.4-13.4 months] in the ECOG PS 0-1 group vs. 9.3 months [95% CI, 4.9-12.8 months]; p = .2718) in the ECOG PS 2-3 group.
The study results demonstrated no significant difference in PFS or OS among the ECOG PS 2-3 and ECOG PS 0-1 groups. Therefore, chemoimmunotherapy should be considered for patients who have ES-SCLC with an ECOG PS of 2-3.
免疫检查点抑制剂联合铂类-依托泊苷是广泛期小细胞肺癌（ES-SCLC）患者的标准一线治疗。导致化疗免疫治疗在 ES-SCLC 中获批的 3 期临床试验排除了 ECOG 体能状态（PS）为 2-3 的患者。因此，关于 ECOG PS 为 2-3 的患者接受化疗免疫治疗的疗效数据有限。
对 2016 年 1 月至 2021 年 1 月期间在梅奥诊所医疗系统接受化疗免疫治疗（阿替利珠单抗或度伐利尤单抗）的 ES-SCLC 患者进行回顾性分析。本研究的目的是比较 ECOG PS 为 0-1 的患者与接受新诊断 ES-SCLC 化疗免疫治疗的 ECOG PS 为 2-3 的患者的总生存期（OS）、无进展生存期（PFS）和最佳临床治疗反应。
共纳入 82 例患者。患者的平均年龄±标准差为 68.1±8.3 岁。其中，56 例患者的 ECOG PS 为 0-1，26 例患者的 ECOG PS 为 2-3。无论 ECOG PS 如何，中位 PFS 均相似（ECOG PS 0-1 组为 5.8 个月[95%CI，4.3-6.0 个月] vs. ECOG PS 2-3 组为 4.1 个月[95%CI，3.8-6.9 个月]；p=0.2994）。中位 OS 也相似，无论 ECOG PS 如何（ECOG PS 0-1 组为 10.6 个月[95%CI，8.4-13.4 个月] vs. ECOG PS 2-3 组为 9.3 个月[95%CI，4.9-12.8 个月]；p=0.2718）。
研究结果表明，ECOG PS 为 2-3 与 ECOG PS 为 0-1 两组之间的 PFS 或 OS 无显著差异。因此，对于 ECOG PS 为 2-3 的 ES-SCLC 患者，应考虑化疗免疫治疗。
