Chen Lingjuan, Kong Yi, Tong Fan, Zhang Ruiguang, Ding Peng, Zhang Sheng, Wang Ye, Zhou Rui, Pu Xingxiang, Chen Bolin, Liang Fei, Tan Qiaoyun, Xu Yu, Wu Lin, Dong Xiaorong
Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, Hubei 430022, China.
Chin Med J (Engl). 2025 Sep 5;138(17):2130-2138. doi: 10.1097/CM9.0000000000003283. Epub 2024 Sep 23.
The purpose of this study was to evaluate the safety and efficacy of subsequent radiotherapy (RT) following first-line treatment with durvalumab plus chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC).
A total of 122 patients with ES-SCLC from three hospitals during July 2019 to December 2021 were retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to address potential confounding factors. The primary focus of our evaluation was to assess the impact of RT on progression-free survival (PFS) and overall survival (OS).
After IPTW analysis, 49 patients received durvalumab plus platinum-etoposide (EP) chemotherapy followed by RT (Durva + EP + RT) and 72 patients received immunochemotherapy (Durva + EP). The median OS was 17.2 months vs . 12.3 months (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.17-0.85, P = 0.020), and the median PFS was 8.9 months vs . 5.9 months (HR: 0.56, 95% CI: 0.32-0.97, P = 0.030) in Durva + EP + RT and Durva + EP groups, respectively. Thoracic radiation therapy (TRT) resulted in longer OS (17.2 months vs . 14.7 months) and PFS (9.1 months vs . 7.2 months) compared to RT directed to other metastatic sites. Among patients with oligo-metastasis, RT also showed significant benefits, with a median OS of 17.4 months vs . 13.7 months and median PFS of 9.8 months vs . 5.9 months compared to no RT. Continuous durvalumab treatment beyond progression (TBP) prolonged OS compared to patients without TBP, in both the Durva + EP + RT (NA vs . 15.8 months, HR: 0.48, 95% CI: 0.14-1.63, P = 0.238) and Durva + EP groups (12.3 months vs . 4.3 months, HR: 0.29, 95% CI: 0.10-0.81, P = 0.018). Grade 3 or 4 adverse events occurred in 13 (26.5%) and 13 (18.1%) patients, respectively, in the two groups; pneumonitis was mostly low-grade.
Addition of RT after first-line immunochemotherapy significantly improved survival outcomes with manageable toxicity in ES-SCLC.
本研究旨在评估度伐利尤单抗联合化疗一线治疗广泛期小细胞肺癌（ES-SCLC）后序贯放疗（RT）的安全性和疗效。
回顾性分析了2019年7月至2021年12月期间来自三家医院的122例ES-SCLC患者。采用治疗权重逆概率（IPTW）分析来处理潜在的混杂因素。我们评估的主要重点是评估放疗对无进展生存期（PFS）和总生存期（OS）的影响。
经过IPTW分析，49例患者接受度伐利尤单抗联合铂类-依托泊苷（EP）化疗后序贯放疗（度伐利尤单抗+EP+RT），72例患者接受免疫化疗（度伐利尤单抗+EP）。度伐利尤单抗+EP+RT组和度伐利尤单抗+EP组的中位OS分别为17.2个月和12.3个月（风险比[HR]：0.38，95%置信区间[CI]：0.17-0.85，P=0.020），中位PFS分别为8.9个月和5.9个月（HR：0.56，95%CI：0.32-0.97，P=0.030）。与针对其他转移部位的放疗相比，胸部放疗（TRT）导致更长的OS（17.2个月对14.7个月）和PFS（9.1个月对7.2个月）。在寡转移患者中，放疗也显示出显著益处，与未接受放疗相比，中位OS为17.4个月对13.7个月，中位PFS为9.8个月对5.9个月。与未进行疾病进展后持续度伐利尤单抗治疗（TBP）的患者相比，疾病进展后持续度伐利尤单抗治疗在度伐利尤单抗+EP+RT组（不可评估对15.8个月，HR：0.48，95%CI：0.14-1.63，P=0.238）和度伐利尤单抗+EP组（12.3个月对4.3个月，HR：0.29，95%CI：0.10-0.81，P=0.018）中均延长了OS。两组分别有13例（26.5%）和13例（18.1%）患者发生3级或4级不良事件；肺炎大多为低级别。
一线免疫化疗后加用放疗可显著改善ES-SCLC的生存结局，且毒性可控。
