Xie Yalin, Li Xiang, Lu Hongxu, Lei An, Li Lei, Jin Yun, Li Yanyang, Cen Wenchang, Zou Weifeng, Su Ning, Liang Jizhen
State Key Laboratory of Respiratory Disease, Department of Oncology, Guangzhou Chest Hospital, Guangzhou Medical University, Guangdong, 510095, People's Republic of China.
Department of Pharmacy, Guangzhou Chest Hospital, Guangzhou Medical University, Guangdong, 510095, People's Republic of China.
Discov Oncol. 2025 May 5;16(1):670. doi: 10.1007/s12672-025-02440-3.
This research effort was designed to retrospectively analyze the safety and efficacy of immune checkpoint inhibitors (ICIs) deployed in combination with chemotherapy in extensive-stage small cell lung cancer (ES-SCLC).
ES-SCLC patients diagnosed at Guangzhou Chest Hospital from January 1, 2018, through June 30, 2022, were divided into two groups: an IEP group (administered ICIs with etoposide and platinum-based chemotherapy) and an EP group (chemotherapy only). Median overall survival (OS) and progression-free survival (PFS) served as the primary endpoints for analysis, while secondary endpoints that were assessed included objective response rate (ORR), 1- and 2-year OS, and safety. Subgroup analyses explored sites of metastatic progression and ICI types.
In total, 102 patients were enrolled, including 33 in the IEP group and 69 in the EP group. The median OS was significantly longer in the IEP group (14.3 vs. 10.8 months, P = 0.028), while the median PFS showed no significant difference (5.9 vs. 5.3 months, P = 0.746). In subgroup analyses, those patients with brain metastases were found to have derived benefit from IEP treatment (median OS 15.9 vs. 8.3 months, hazard ratio [HR], 0.266 [95% CI, 0.087 to 0.817], P = 0.014). The PFS of patients administered PD-L1 inhibitors was longer than that of those administered PD-1 inhibitors (median 7.0 vs. 3.5 months; HR, 0.342 [95% CI, 0.141 to 0.832], P = 0.014). The safety profile of the IEP regimen was favorable, although these patients were more likely to experience immune-related pneumonia (12.1% vs. 1.4%, P = 0.020). Subgroups analyses showed that patients with a history of smoking (HR = 0.54, 95% CI: 0.31-0.94) and brain metastases (HR = 0.27, 95% CI: 0.09-0.82) were more likely to benefit from IEP treatment.
The combination of ICIs and chemotherapy can afford better survival outcomes for ES-SCLC patients, especially in individuals suffering from brain metastases, and they should thus be considered as promising first-line treatment options. However, careful management of immune-related adverse events is crucial.
本研究旨在回顾性分析免疫检查点抑制剂（ICIs）联合化疗应用于广泛期小细胞肺癌（ES-SCLC）的安全性和疗效。
将2018年1月1日至2022年6月30日在广州胸科医院确诊的ES-SCLC患者分为两组：IEP组（接受ICIs联合依托泊苷和铂类化疗）和EP组（仅接受化疗）。总生存期中位数（OS）和无进展生存期中位数（PFS）作为主要分析终点，同时评估的次要终点包括客观缓解率（ORR）、1年和2年OS以及安全性。亚组分析探讨转移进展部位和ICI类型。
共纳入102例患者，其中IEP组33例，EP组69例。IEP组的中位OS显著更长（14.3个月对10.8个月，P = 0.028），而中位PFS无显著差异（5.9个月对5.3个月，P = 0.746）。在亚组分析中，发现有脑转移的患者从IEP治疗中获益（中位OS 15.9个月对8.3个月，风险比[HR]，0.266[95%CI，0.087至0.817]，P = 0.014）。接受PD-L1抑制剂治疗的患者的PFS长于接受PD-1抑制剂治疗的患者（中位7.0个月对3.5个月；HR，0.342[95%CI，0.141至0.832]，P = 0.014）。IEP方案的安全性良好，尽管这些患者更易发生免疫相关肺炎（12.1%对1.4%，P = 0.020）。亚组分析显示，有吸烟史（HR = 0.54，95%CI：0.31 - 至0.94）和脑转移（HR = 0.27，95%CI：0.09 - 0.82）的患者更可能从IEP治疗中获益。
ICIs与化疗联合可为ES-SCLC患者带来更好的生存结果，尤其是对于有脑转移的患者，因此应被视为有前景的一线治疗选择。然而，仔细管理免疫相关不良事件至关重要。
