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Bonanno L, Calvetti L, Dal Maso A, Pavan A, Bao LC, De Nuzzo M, Frega S, Sartori G, Ferro A, Pasello G, Morandi P, Aprile G, Guarneri V. Real-world impact of the introduction of chemo-immunotherapy in extended small cell lung cancer: a multicentric analysis. Front Immunol 2024; 15:1353889. [PMID: 38322260 PMCID: PMC10845350 DOI: 10.3389/fimmu.2024.1353889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 02/08/2024] Open
Abstract
Background Recent clinical trials demonstrated longer survival in extended small cell lung cancer (SCLC) patients treated with immunotherapy in addition to chemotherapy. However, the magnitude of benefit is modest and the impact in real-world setting has to be fully established. Methods We collected clinical data and radiological imaging of patients affected by extended or relapsing SCLC and consecutively treated according to clinical practice between 2016 and 2023. As primary end-point, we compared pre-defined outcome indicators before and after the introduction of chemo-immunotherapy (May 2020): 6-month and 12-month progression free survival (PFS) rate, 12-month and 18-month overall survival (OS). Among those who were treated after May 2020, patients who did not receive immunotherapy according to treating physician's choice were included in the analysis to minimize clinical selection bias. Results The analysis included 214 patients: 132 (61.7%) were treated in an Academic cancer center and 82 (38.3%) in two community hospitals; 104 were treated before May 2020. Median PFS of the overall study population was 4.8 months (95% confidence interval [95% CI]: 4.4-5.4), median OS was 7.1 months (95% CI: 6.3-7.7). Estimated PFS and OS were significantly longer in patients treated after May 2020 with hazard ratio (HR) for PFS and OS of 0.61 (95% CI: 0.46-0.81, p < 0.001) and 0.70 (95% CI: 0.52-0.93, p = 0.015), respectively. 6-month PFS rate increased from 27% to 40% (p = 0.04) while 12-months PFS raised from 1% to 11% (p = 0.003). 12-month and 18-month OS rate increased from 15% to 28% (p = 0.03) and from 2.1% to 12% (p = 0.009), respectively. After May 2020 the median number of hospitalization days per patient decreased significantly and the incidence of severe AEs was similar. Among patients treated with chemo-immunotherapy, the onset of immune-related AEs was associated with improved PFS and OS (HR 0.55, 95% CI: 0.35-0.89, p = 0.012 and HR 0.47, 95%CI 0.28-0.77, p = 0.002, respectively). Conclusions The real-world analysis shows a meaningful improvement of outcome indicators after the introduction of chemo-immunotherapy, with reduction of the duration of hospitalization, thus supporting the use of chemo-immunotherapy and the need for further biomarker research.
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Affiliation(s)
- Laura Bonanno
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Lorenzo Calvetti
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | | | - Alberto Pavan
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Loc Carlo Bao
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Mattia De Nuzzo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Stefano Frega
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Sartori
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Alessandra Ferro
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Giulia Pasello
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Paolo Morandi
- Medical Oncology Department, Azienda ULSS 3 Serenissima, Dell’Angelo General Hospital, Mestre and SS Giovanni e Paolo General Hospital, Venezia, Italy
| | - Giuseppe Aprile
- Department of Oncology, Azienda ULSS 8 Berica, San Bortolo General Hospital, Vicenza, Italy
| | - Valentina Guarneri
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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