A Real-World Analysis of Anti-Programmed Death-Ligand 1 (PD-L1) Immune Checkpoint Inhibitor Treatments Combined with Chemotherapy in Untreated Extensive Stage Small Cell Lung Cancer

Abstract

Abstract 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).