Gomez-Randulfe Igor, Silva Díaz Sofía, Escriu Carles, Mohammed Saara, Shah Riyaz, Benitez Fuentes Javier David, Cox Samantha, Monaca Federico, Bria Emilio, García-Campelo María Rosario, Crook Benjamin, Talbot Toby, Leporati Rita, Balachandran Kirsty, Newsom-Davis Tom, Hughes Sarah, Cove-Smith Laura, Taylor Paul, Blackhall Fiona, Califano Raffaele
Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain.
Ther Adv Med Oncol. 2024 Sep 19;16:17588359241272957. doi: 10.1177/17588359241272957. eCollection 2024.
Second-line treatment for small-cell lung cancer (SCLC) is primarily guided by the time elapsed since the last platinum dose. Rechallenge with carboplatin and etoposide has demonstrated superior outcomes compared to topotecan if the platinum-free interval (PFI) is longer than 90 days and is considered the standard of care. However, these findings predate the chemo-immunotherapy era. This study investigates the effectiveness of the rechallenge strategy after chemo-immunotherapy in a real-world setting.
We retrospectively reviewed patients with the extensive stage (ES)-SCLC who received rechallenge with carboplatin and etoposide after first-line chemoimmunotherapy between September 2020 and August 2023 in nine European centres. Demographic and clinical data were collected and analysed.
A total of 93 patients were included. Sixty-six (71%) patients had a PFI between 3 and 6 months. Consolidation thoracic radiotherapy and prophylactic cranial irradiation had been administered in 31 (33.3%) patients and 20 (21.5%) patients, respectively. Overall response rate was 59.1%. Median progression-free survival (PFS) was 5 months (95% confidence interval (CI) 4.3-5.7) and median overall survival (OS) was 7 months (95% CI 5.7-8.3). Notably, PFS and OS were not different according to PFI (3-6 m vs > 6 m).
Rechallenge with carboplatin and etoposide is a valid second-line option in patients with ES-SCLC whose disease progresses after first-line chemoimmunotherapy. Our analysis shows similar results to previous studies. Furthermore, outcomes were consistent across patients with different PFIs, confirming its efficacy in patients with a PFI longer than 3 months.
小细胞肺癌（SCLC）的二线治疗主要依据自上次铂类药物给药后的时间来指导。如果无铂间期（PFI）超过90天，与拓扑替康相比，再次使用卡铂和依托泊苷已显示出更好的疗效，并且被视为标准治疗方案。然而，这些研究结果早于化疗免疫治疗时代。本研究在真实世界环境中调查了化疗免疫治疗后再次挑战策略的有效性。
我们回顾性分析了2020年9月至2023年8月期间在九个欧洲中心接受一线化疗免疫治疗后再次使用卡铂和依托泊苷治疗的广泛期（ES）-SCLC患者。收集并分析了人口统计学和临床数据。
共纳入93例患者。66例（71%）患者的PFI在3至6个月之间。分别有31例（33.3%）患者和20例（21.5%）患者接受了巩固性胸部放疗和预防性颅脑照射。总缓解率为59.1%。中位无进展生存期（PFS）为5个月（95%置信区间（CI）4.3 - 5.7），中位总生存期（OS）为7个月（95% CI 5.7 - 8.3）。值得注意的是，根据PFI（3 - 6个月与> 6个月），PFS和OS并无差异。
对于一线化疗免疫治疗后疾病进展的ES-SCLC患者，再次使用卡铂和依托泊苷是一种有效的二线选择。我们的分析显示出与先前研究相似的结果。此外，不同PFI的患者结果一致，证实了其在PFI超过3个月的患者中的疗效。
