Efficacy and safety of first-line immune checkpoint inhibitors combined with chemotherapy in extensive-stage small cell lung cancer
10.3760/cma.j.cn431274-20240817-01270
- VernacularTitle:广泛期小细胞肺癌一线免疫检查点抑制剂联合化疗的疗效及安全性
- Author:
Qiu ZONG
1
;
Qin LI
1
;
Pengfei SONG
1
Author Information
1. 连云港市第一人民医院呼吸与危重症医学科，连云港 222000
- Publication Type:Journal Article
- Keywords:
Small cell lung carcinoma;
Immune checkpoint inhibitors;
Drug therapy, combination;
Neoplasm metastasis
- From:
Journal of Chinese Physician
2025;27(7):1040-1044
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of first-line immune checkpoint inhibitors (ICIs) combined with chemotherapy in the treatment of extensive-stage small cell lung cancer (ESCLC).Methods:Clinical data of 109 ESCLC patients admitted to the First People′s Hospital of Lianyungang from January 2019 to December 2023 were retrospectively collected. According to different treatment methods, patients were divided into the immunochemotherapy group (first-line treatment with ICIs combined with chemotherapy) and the chemotherapy group (chemotherapy alone). Kaplan-Meier method was used for survival analysis of patients with different treatment methods, and a Cox regression model was established to analyze the factors affecting the prognosis of ESCLC patients.Results:A total of 109 patients were included, with 43 cases (39.4%) in the immunochemotherapy group and 66 cases (60.6%) in the chemotherapy group. At the first efficacy evaluation, there were no significant differences in objective response rate (ORR) and disease control rate (DCR) between the two groups (all P>0.05). There were no significant differences in the proportions of grade 3-4 myelosuppression and radiation pneumonia between the two groups (all P> 0.05), and only 2 cases (4.7%) in the immunochemotherapy group had severe immune-related adverse events (irAE). The overall survival (OS) of the immunochemotherapy group was longer than that of the chemotherapy group (13.6 months vs 11.5 months, P=0.024), but the median progression-free survival (PFS) showed no significant difference compared to the chemotherapy group (8.4 months vs 6.0 months, P=0.068). Among patients without liver or brain metastasis, the OS of the immunochemotherapy group was longer than that of the chemotherapy group (19.3 months vs 12.1 months, P=0.017), while among patients with liver or brain metastasis, there was no significant difference in OS between the two groups ( P>0.05). Multivariate Cox regression analysis showed that male gender ( HR=0.284, 95% CI: 0.133-0.605, P=0.001), first-line ICIs treatment ( HR=0.607, 95% CI: 0.372-0.988, P=0.045), and chest radiotherapy ( HR=0.538, 95% CI: 0.307-0.942, P=0.030) were independent protective factors for the prognosis of ESCLC patients, and liver metastasis ( HR=1.907, 95% CI: 1.191-3.053, P=0.007) was an independent risk factor. Conclusions:First-line ICIs combined with chemotherapy can significantly prolong the OS of ESCLC patients with good safety. Patients without liver or brain metastasis benefit more significantly from immunotherapy.
