Department of Thoracic Oncology, Strasbourg University Hospital, Strasbourg, France.
Department of Radiation Oncology, Claudius Regaud Institute, Cancer University Institute of Toulouse Oncopole, Toulouse, France.
BMC Cancer. 2024 Apr 5;24(1):421. doi: 10.1186/s12885-024-12117-9.
We designed this study based on both a physician practice survey and real-world patient data to: (1) evaluate clinical management practices in extensive-stage small cell lung cancer (ES-SCLC) among medical centers located across France; and (2) describe first-line treatment patterns among patients with ES-SCLC following the introduction of immunotherapy into clinical practice.
A 50-item questionnaire was completed by physicians from 45 medical centers specialized in SCLC management. Responses were collected from June 2022 to January 2023. The survey questions addressed diagnostic workup of ES-SCLC, chemoimmunotherapy in first-line and second-line settings, and use of prophylactic cranial irradiation (PCI) and radiotherapy. In parallel, using a chart review approach, we retrospectively analyzed aggregated information from 548 adults with confirmed ES-SCLC receiving first-line treatment in the same centers.
In ES-SCLC, treatment planning is based on chest computed tomography (CT) (as declared by 100% of surveyed centers). Mean time between diagnosis and treatment initiation was 2-7 days, as declared by 82% of centers. For detection of brain metastases, the most common imaging test was brain CT (84%). The main exclusion criteria for first-line immunotherapy in the centers were autoimmune disease (87%), corticosteroid therapy (69%), interstitial lung disease (69%), and performance status ≥ 2 (69%). Overall, 53% and 36% of centers considered that patients are chemotherapy-sensitive if they relapse within ≥ 3 months or ≥ 6 months after first-line chemoimmunotherapy, respectively. Among the 548 analyzed patients, 409 (75%) received chemoimmunotherapy as a first-line treatment, 374 (91%) of whom received carboplatin plus etoposide and 35 (9%) cisplatin plus etoposide. Overall, 340/548 patients (62%) received maintenance immunotherapy. Most patients (68%) did not receive radiotherapy or PCI.
There is an overall alignment of practices reflecting recent clinical guidelines among medical centers managing ES-SCLC across France, and a high prescription rate of immunotherapy in the first-line setting.
本研究基于医师实践调查和真实世界患者数据，旨在：（1）评估法国各地小细胞肺癌（SCLC）治疗中心广泛期小细胞肺癌（ES-SCLC）的临床管理实践；（2）描述免疫疗法引入临床实践后 ES-SCLC 患者的一线治疗模式。
45 家 SCLC 管理专业医疗中心的医师完成了一份 50 项的调查问卷。该调查于 2022 年 6 月至 2023 年 1 月期间收集回复。调查问题涉及 ES-SCLC 的诊断性检查、一线和二线化疗免疫治疗、预防性颅脑照射（PCI）和放疗的应用。同时，我们使用图表回顾的方法，回顾性分析了在相同中心接受一线治疗的 548 名确诊为 ES-SCLC 的成人的汇总信息。
在 ES-SCLC 中，治疗计划基于胸部计算机断层扫描（CT）（97%的调查中心申报）。诊断与治疗开始之间的平均时间为 2-7 天，82%的中心申报。对于脑转移的检测，最常见的影像学检查是脑部 CT（84%）。中心一线免疫治疗的主要排除标准是自身免疫性疾病（87%）、皮质类固醇治疗（69%）、间质性肺病（69%）和表现状态≥2（69%）。总体而言，53%和 36%的中心认为，如果患者在一线化疗免疫治疗后 3 个月或 6 个月内复发，则为化疗敏感。在分析的 548 名患者中，409 名（75%）接受化疗免疫治疗作为一线治疗，其中 374 名（91%）接受卡铂加依托泊苷，35 名（9%）接受顺铂加依托泊苷。总体而言，340/548 名患者（62%）接受维持性免疫治疗。大多数患者（68%）未接受放疗或 PCI。
法国各地管理 ES-SCLC 的医疗中心的实践总体上与最近的临床指南一致，一线治疗中免疫治疗的处方率较高。
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