Role of radiotherapy in extensive-stage small cell lung cancer after durvalumab-based immunochemotherapy: A retrospective study.
10.1097/CM9.0000000000003283
- Author:
Lingjuan CHEN
1
;
Yi KONG
2
;
Fan TONG
1
;
Ruiguang ZHANG
1
;
Peng DING
1
;
Sheng ZHANG
1
;
Ye WANG
1
;
Rui ZHOU
1
;
Xingxiang PU
2
;
Bolin CHEN
2
;
Fei LIANG
3
;
Qiaoyun TAN
1
;
Yu XU
4
;
Lin WU
2
;
Xiaorong DONG
1
Author Information
1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
2. Department of Thoracic Medical Oncology, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410000, China.
3. Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai 200000, China.
4. Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, China.
- Publication Type:Journal Article
- Keywords:
Durvalumab;
Immune checkpoint inhibitor;
Radiotherapy;
Small cell lung cancer;
Treatment beyond progression
- MeSH:
Humans;
Small Cell Lung Carcinoma/therapy*;
Retrospective Studies;
Male;
Female;
Middle Aged;
Lung Neoplasms/therapy*;
Aged;
Antibodies, Monoclonal/therapeutic use*;
Adult;
Immunotherapy/methods*;
Aged, 80 and over
- From:
Chinese Medical Journal
2025;138(17):2130-2138
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:The purpose of this study was to evaluate the safety and efficacy of subsequent radiotherapy (RT) following first-line treatment with durvalumab plus chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC).
METHODS:A total of 122 patients with ES-SCLC from three hospitals during July 2019 to December 2021 were retrospectively analyzed. Inverse probability of treatment weighting (IPTW) analysis was performed to address potential confounding factors. The primary focus of our evaluation was to assess the impact of RT on progression-free survival (PFS) and overall survival (OS).
RESULTS:After IPTW analysis, 49 patients received durvalumab plus platinum-etoposide (EP) chemotherapy followed by RT (Durva + EP + RT) and 72 patients received immunochemotherapy (Durva + EP). The median OS was 17.2 months vs . 12.3 months (hazard ratio [HR]: 0.38, 95% confidence interval [CI]: 0.17-0.85, P = 0.020), and the median PFS was 8.9 months vs . 5.9 months (HR: 0.56, 95% CI: 0.32-0.97, P = 0.030) in Durva + EP + RT and Durva + EP groups, respectively. Thoracic radiation therapy (TRT) resulted in longer OS (17.2 months vs . 14.7 months) and PFS (9.1 months vs . 7.2 months) compared to RT directed to other metastatic sites. Among patients with oligo-metastasis, RT also showed significant benefits, with a median OS of 17.4 months vs . 13.7 months and median PFS of 9.8 months vs . 5.9 months compared to no RT. Continuous durvalumab treatment beyond progression (TBP) prolonged OS compared to patients without TBP, in both the Durva + EP + RT (NA vs . 15.8 months, HR: 0.48, 95% CI: 0.14-1.63, P = 0.238) and Durva + EP groups (12.3 months vs . 4.3 months, HR: 0.29, 95% CI: 0.10-0.81, P = 0.018). Grade 3 or 4 adverse events occurred in 13 (26.5%) and 13 (18.1%) patients, respectively, in the two groups; pneumonitis was mostly low-grade.
CONCLUSION:Addition of RT after first-line immunochemotherapy significantly improved survival outcomes with manageable toxicity in ES-SCLC.
