Lee Kyoungmin, Kim Tae-Hwan, Yong Lee Sung, Lee Yun-Gyoo, Choi Juwhan, Choi Jin-Hyuk, Yoon Choi Jung, Lim Ah-Reum, Sun Kim Jung, Won Lee Ji, Ji Choi Yoon, Hyun Park Ji, Namgung Yoon, Kyung Ahn Hee, Joo Kang Eun
Division of Oncology/Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea.
Lung Cancer. 2025 Mar;201:108455. doi: 10.1016/j.lungcan.2025.108455. Epub 2025 Feb 19.
The combination of atezolizumab with etoposide and carboplatin (AECb) has become a new standard of care for extensive-stage small-cell lung cancer (ES-SCLC). This study evaluates its impact on central nervous system (CNS) progression, specifically brain metastases.
We analyzed the outcomes of 550 ES-SCLC patients who received first-line therapy between 2016 and 2022, focusing on time to intracranial progression (TTicP), progression-free survival (PFS), and overall survival (OS).
Of the 550 patients, 247 (44.9 %) received AECb, while 303 (55.1 %) received conventional chemotherapy (CTx). Intracranial progression occurred in 179 patients (32.5 %), with the AECb group showing a significantly prolonged TTicP compared to the CTx group (median 24.4 vs. 14.3 months; p = 0.038). In patients without brain metastasis at diagnosis (n = 408), TTicP was also longer in the AECb group (27.2 vs. 15.3 months; p = 0.016). This benefit persisted even after excluding patients who underwent prophylactic cranial irradiation (PCI) (27.2 vs. 15.2 months; p = 0.02) (n = 394). These findings remained consistent after adjusting for age, initial metastatic site, and PCI. Additionally, the AECb group showed improved PFS (5.0 vs. 4.7 months; p = 0.004) and OS (11.1 vs. 9.8 months; p = 0.003).
Our findings suggest that the AECb regimen is superior to conventional chemotherapy in delaying CNS progression and controlling systemic disease in ES-SCLC. These results support the AECb regimen as the new standard of care. Further research is needed to explore the mechanisms behind these improved CNS outcomes and to reassess the necessity of PCI in this treatment era.
阿替利珠单抗联合依托泊苷和卡铂（AECb）已成为广泛期小细胞肺癌（ES-SCLC）的新治疗标准。本研究评估其对中枢神经系统（CNS）进展，特别是脑转移的影响。
我们分析了2016年至2022年间接受一线治疗的550例ES-SCLC患者的结局，重点关注颅内进展时间（TTicP）、无进展生存期（PFS）和总生存期（OS）。
550例患者中，247例（44.9%）接受了AECb治疗，而303例（55.1%）接受了传统化疗（CTx）。179例患者（32.5%）发生颅内进展，AECb组的TTicP明显长于CTx组（中位数24.4个月对14.3个月；p = 0.038）。在诊断时无脑转移的患者（n = 408）中，AECb组的TTicP也更长（27.2个月对15.3个月；p = 0.016）。即使排除接受预防性颅脑照射（PCI）的患者后，这种益处仍然存在（27.2个月对15.2个月；p = 0.02）（n = 394）。在调整年龄、初始转移部位和PCI后，这些结果仍然一致。此外，AECb组的PFS（5.0个月对4.7个月；p = 0.004）和OS（11.1个月对9.8个月；p = 0.003）有所改善。
我们的研究结果表明，在延迟ES-SCLC的CNS进展和控制全身疾病方面，AECb方案优于传统化疗。这些结果支持AECb方案作为新的治疗标准。需要进一步研究以探索这些改善的CNS结局背后的机制，并重新评估在这个治疗时代PCI的必要性。
