Real-World Efficacy and Safety of Thoracic Radiotherapy after First-Line Chemo-Immunotherapy in Extensive-Stage Small-Cell Lung Cancer

Zhaoliang Xie; Jingru Liu; Min Wu; Xiaohan Wang; Yuhan Lu; Chunyan Han; Lei Cong; Jisheng Li; Xue Meng

doi:10.3390/jcm12113828

Real-World Efficacy and Safety of Thoracic Radiotherapy after First-Line Chemo-Immunotherapy in Extensive-Stage Small-Cell Lung Cancer

J Clin Med. 2023 Jun 2;12(11):3828. doi: 10.3390/jcm12113828.

Authors

Zhaoliang Xie¹, Jingru Liu², Min Wu³, Xiaohan Wang¹, Yuhan Lu⁴, Chunyan Han⁵, Lei Cong⁶, Jisheng Li⁷, Xue Meng¹

Affiliations

¹ Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan 250117, China.
² Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University Cancer Center, Jinan 250117, China.
³ Suzhou Cancer Center Core Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China.
⁴ Department of Emergency Medicine, The First People's Hospital of Neijiang, Neijiang 641099, China.
⁵ Department of Radiotherapy, The Third Affiliated Hospital of Shandong First Medical University, Jinan 250031, China.
⁶ Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250117, China.
⁷ Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan 250012, China.

Abstract

(1) Background: At present, the efficacy and safety of thoracic radiotherapy (TRT) after chemo-immunotherapy (CT-IT) in patients with extensive-stage small-cell lung cancer (ES-SCLC) still remain unclear. The purpose of this study was to evaluate the role of TRT after CT-IT in patients with ES-SCLC. (2) Methods: From January 2020 to October 2021, patients with ES-SCLC treated with first-line anti-PD-L1 antibody plus platinum-etoposide chemotherapy were enrolled retrospectively. The survival data and adverse events data of patients treated with or without TRT after CT-IT were collected for analysis. (3) Results: A total of 118 patients with ES-SCLC treated with first-line CT-IT were retrospectively enrolled, with 45 patients with TRT and 73 patients without TRT after CT-IT. The median PFS and OS in the CT-IT + TRT group and CT-IT only group were 8.0 months versus 5.9 months (HR = 0.64, p = 0.025) and 22.7 months versus 14.7 months (HR = 0.52, p = 0.015), respectively. The median PFS and OS in all 118 patients treated with first-line CT-IT were 7.2 and 19.8 months with an ORR of 72.0%. In multivariate analyses, liver metastasis and response to CT-IT were shown to be independent prognostic factors of PFS (p < 0.05), while liver metastasis and bone metastasis were independent predictive factors of OS (p < 0.05). Although TRT was significantly associated with better PFS and OS in univariate analysis, the association of TRT and OS failed to reach statistical significance (HR = 0.564, p = 0.052) in multivariate analysis. There was no significant difference in adverse events (AEs) between two treatment groups (p = 0.58). (4) Conclusions: ES-SCLC patients treated with TRT after first-line CT-IT had prolonged PFS and OS with an acceptable safety profile. Further prospective randomized studies are necessary to explore the efficacy and safety of this treatment modality for ES-SCLC in future.

Keywords: adverse event; chemo-immunotherapy (CT-IT); extensive-stage small-cell lung cancer (ES-SCLC); survival; thoracic radiotherapy (TRT).

Abstract

Grants and funding