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Background
Extensive-stage small-cell lung cancer (ES-SCLC) is an incurable cancer with poor prognosis in which characteristics predictive of long-term survival are debated. The utility of agents such as immune checkpoint inhibitors highlights the importance of identifying key characteristics and treatment strategies that contribute to long-term su...
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Background
Although therapy for limited-stage small-cell lung cancer (LS-SCLC) is administered with curative intent, most patients relapse and eventually die of recurrent disease. Chemotherapy (CT) with concurrent radiotherapy (RT) remains the standard of care for LS-SCLC; however, this could evolve in the near future. Therefore, understanding the...
Citations
... ECOG PS, referring to a measure of functional status, has been used as an independent predictive factor, with higher scores being associated with poorer outcomes. ECOG PS 1-2 patients had a medium-term survival rate of 68.1% and a long-term survival rate of 65.1%, while ECOG PS 3-4 patients had a medium-term survival rate of 18.1% and a long-term survival rate of 0% (15). Another study also demonstrated that patients with PS 2-3 showed significantly poorer OS compared to patients with PS 0-1 (16). ...
... The presence of brain as well as hepatic metastases is a hallmark of increased disease volume and reduced therapeutic efficacy. Individual research has demonstrated that liver and brain metastases are negative prognostic factors; however, these findings are limited to individuals treated with first-line systemic chemotherapy (15,16). Moreover, there has not been a detailed investigation of the immunotherapy impacts on this component. ...
Purpose
In this study, we aimed to develop a predictive model for patients receiving chemotherapy and immunotherapy for extensive-stage small cell lung cancer
Methods
We retrospectively analyzed 112 extensive-stage small cell lung cancer patients treated with first-line immunotherapy and chemotherapy. The relevant clinical data were collected to evaluate the changes during the treatment. The best subset regression, univariate analysis, and LASSO regression with cross-validation were applied for variable selection and model establishment. The nomograms for 1- and 2-year survival probabilities were established, and the calibration curve was utilized to evaluate the correspondence between actual and predicted survival. The model prediction capacity was assessed using decision curve analysis, calibration curves, and receiver operating characteristic curves. Moreover, five-fold cross-validation was conducted for internal validation. According to risk score, the patients were assigned to high- and low-risk groups, and survival curves were generated for each group.
Results
The LASSO regression model was established based on the variables such as age, ECOG, metastatic sites, NLR, and immunotherapy cycles. This predictive model displayed robust performance, evidenced by the Area Under the Curve of 0.887 and concordance index of 0.759. The nomogram effectively predicted 1- and 2-year survival probabilities and demonstrated a high degree of calibration. The decision curve analysis displayed that the model possessed superior predictive capability. The risk stratification for patients with high- and low-risk categories facilitated more individualized survival assessment.
Conclusion
The study successfully developed a prognostic model for extensive-stage small cell lung cancer patients undergoing immunotherapy and chemotherapy, demonstrating the good accuracy and predictability.
... The overall two-year survival rate is 8% of all cases. The origin of this type of cancer is neuroendocrine, and long-term smoking is a proven risk factor in this type of cancer [1][2][3][4][5][6][7]. ...
... Only 56.1% of the patients included in the study received Cisplatin and 45.6% underwent radiotherapy of the thorax. Very few patients underwent prophylactic cranial radiation [1]. ...
Introduction: Small-cell lung cancer (SCLC) is an aggressive form of cancer with a poor prognosis. The two-year survival rate is 8% of all cases. Case presentation: We present the case of a male patient who was 50 years old at the time of diagnosis in May 2022. He was diagnosed with extensive-stage small-cell lung cancer, treated with immunotherapy in combination with chemotherapy (Durvalumab in combination with Etoposide plus Carboplatin) as a first-line treatment, followed by maintenance immunotherapy. In December 2023, a PET-CT scan revealed progressive disease with multiple metastases. Chemotherapy was reinitiated with Etoposide plus Cisplatin in January 2024. After two cycles of chemotherapy, the patient developed post-chemotherapy anemia, for which treatment with Epoetinum alpha was initiated. Chemotherapy was continued for another five cycles, until May 2024, with the maintenance of hemoglobin at a level within 9.9 mg/dL–11 mg/dL. Upon assessment at the end of May 2024, the patient presented an ECOG = 2 performance status, with a moderate general state, moderate-intensity fatigue, no pain, no anxiety or depression and no dyspnea. Discussions, Literature Review and Conclusions: Reinitiating chemotherapy after the failure of maintenance immunotherapy may be an option in patients with SCLC. Epoetinum allows oncological treatment by preventing chemotherapy-induced anemia.
... The serum LDH concentration is another prognostic factor that is frequently identified in patients with malignancies [19,23,24,32,33]. LDH is an essential enzyme in glycolysis and functions through catalyzing the conversion of pyruvate to lactate. ...
... Therefore, elevated serum LDH levels may reflect increased cancer cell activation and are associated with poor prognosis in cancer patients [34]. The results of our study are compatible with those of previous studies [19,23,24,[32][33][34][35], and LDH was identified as a factor associated with unfavorable outcomes in extensive-stage SCLC patients who received first-line anti-PD-L1 ICIs combined with chemotherapy. The three female patients in this study had significantly shorter OS than the male patients. ...
Real-world clinical experience of using anti-programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs) combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer (SCLC) patients has rarely been reported. In this study, we aimed to perform a retrospective multicenter clinical analysis of extensive-stage SCLC patients receiving first-line therapy with anti-PD-L1 ICIs combined with chemotherapy. Between November 2018 and March 2022, 72 extensive-stage SCLC patients receiving first-line atezolizumab or durvalumab in combination with chemotherapy, according to the cancer center databases of Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals, were retrospectively included in the analysis. Twenty-one patients (29.2%) received atezolizumab and fifty-one (70.8%) received durvalumab. Objective response (OR) and disease control (DC) rates of 59.7% and 73.6%, respectively, were observed with first-line ICI plus chemotherapy. The median progression-free survival (PFS) was 6.63 months (95% confidence interval (CI), 5.25–8.02), and the median overall survival (OS) was 16.07 months (95% CI, 15.12–17.0) in all study patients. A high neutrophil-to-lymphocyte ratio (NLR; >4) and a high serum lactate dehydrogenase (LDH) concentration (>260 UL) were identified as independent unfavorable factors associated with shorter OS in the multivariate analysis. Regarding safety, neutropenia was the most common grade 3 treatment-related adverse event (AE), but no treatment-related deaths occurred in the study patients. First-line anti-PD-L1 ICIs combined with chemotherapy are effective and safe for male extensive-stage SCLC patients. Further therapeutic strategies may need to be developed for patients with unfavorable outcomes (e.g., baseline high NLR and serum LDH level).
... The serum LDH concentration is another prognostic factor frequently identi ed in patients with malignancies [17,21,22,26,27]. LDH is an essential enzyme in glycolysis and functions in catalyzing the conversion of pyruvate to lactate; elevated serum LDH levels have been used as an in ammatory index [28]. ...
... Therefore, elevated serum LDH levels may re ect increased cancer cell activation and are associated with poor prognosis in cancer patients [28]. The results of our study are compatible with those of previous studies [17,21,22,[26][27][28][29], and LDH was identi ed as a factor associated with unfavorable outcomes in extensive-stage SCLC patients who received rst-line anti-PD-L1 ICIs combined with chemotherapy. ...
Purpose: The real-world clinical experience of using anti-programmed death-ligand 1 (PD-L1) immune checkpoint inhibitors (ICIs) combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer (SCLC) patients has rarely been reported. In this study, we aimed to perform a retrospective multicenter clinical analysis of extensive-stage SCLC patients receiving first-line therapy with anti-PD-L1 ICIs combined with chemotherapy.
Methods: Between November 2018 and March 2022, 72 extensive-stage SCLC patients receiving first-line atezolizumab or durvalumab in combination with chemotherapy according to the cancer center database of Linkou, Chiayi, and Kaohsiung Chang Gung Memorial Hospitals were retrospectively included in the analysis.
Results: Twenty-one patients (29.2%) received atezolizumab, and 51 (70.8%) received durvalumab. Objective response (OR) and disease control (DC) rates of 59.7% and 73.6% were observed with first-line ICI plus chemotherapy. The median progression-free survival (PFS) was 6.63 months (95% confidence interval (CI), 5.25–8.02), and the median overall survival (OS) was 16.07 months (95% CI, 15.12–17.0) in all study patients. A high neutrophil-to-lymphocyte ratio (NLR) (>4) and a high serum lactate dehydrogenase (LDH) concentration (>260 UL) were identified as independent unfavorable factors associated with shorter OS in multivariate analysis. Regarding safety, neutropenia was the most common grade 3 treatment-related adverse event (AE), but no treatment-related deaths occurred in the study patients.
Conclusion: First-line anti-PD-L1 ICIs combined with chemotherapy are effective and safe for extensive-stage SCLC. Further therapeutic strategies may need to be developed for patients with unfavorable outcomes (baseline high NLR and serum LDH level).
