Platinum plus etoposide with durvalumab for extensive-stage small-cell lung cancer with untreated brain metastases: a multicenter, single-arm phase II trial (LOGiK2001, SPEED)

Abstract

Background: The efficacy of immunotherapy combined with platinum-based chemotherapy for untreated brain metastases originating from small-cell lung cancer (SCLC) has remained unclear.

Methods: This multicenter, single-arm phase II study enrolled chemotherapy-naive patients with extensive-stage SCLC who had at least one untreated brain metastasis measuring ≥5 mm. Patients received durvalumab (MEDI4736) combined with platinum-etoposide chemotherapy for four cycles, followed by durvalumab maintenance monotherapy. The primary endpoint was the intracranial response rate, assessed using the modified RECIST for brain metastases, with target lesions defined as ≥5 mm.

Results: A total of 42 patients from 23 institutions were enrolled. Their median age was 70.5 years (range 35-83 years), and the median size of target brain lesions was 10 mm (range 5-57 mm). The intracranial response rate (as assessed by the modified RECIST) was 66.7% (90% confidence interval 54.0% to 77.3%), meeting the study's primary endpoint. Intracranial and extracranial lesion responses were generally consistent. The median intracranial progression-free survival was 4.2 months, with a median time to local brain therapy of 10.4 months. Subsequent local brain therapy was administered to 21 patients (50.0%), including surgery in 2, whole-brain radiotherapy in 12, and stereotactic radiotherapy in 7 patients.

Conclusions: Durvalumab combined with platinum-etoposide chemotherapy demonstrated promising intracranial activity in SCLC patients with untreated brain metastases. However, only a small proportion of patients achieved a sustained response, highlighting the need for regular monitoring of brain metastases.

Keywords: brain metastasis; durvalumab; immune checkpoint inhibitor; small-cell lung cancer.