2023 World Conference on Lung Cancer (Posters)-EP13.03. Real-World Analysis of ICI Efficacy in ES-SCLC Patients with and without Brain Metastases: A Call for Inclusion in Clinical Trials

EP13.03. Real-World Analysis of ICI Efficacy in ES-SCLC Patients with and without Brain Metastases: A Call for Inclusion in Clinical Trials - PDF(Slides)

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A study conducted at the Dartmouth Hitchcock Medical Center examined the efficacy of immune checkpoint inhibitors (ICIs) in treating extensive stage small-cell lung cancer (ES-SCLC) patients with and without brain metastases (BM). Despite the high incidence of BM in SCLC patients, they are often excluded from clinical trials due to their perceived poor prognosis. The study aimed to determine the disease response and management of intracranial disease in ES-SCLC patients treated with ICIs.<br /><br />A total of 83 patients with biopsy-confirmed ES-SCLC who received at least one cycle of atezolizumab/carboplatin/etoposide combination were included in the study, with 39.3% of them having BM. The median follow-up was 8 months. Disease progression occurred in 90.9% of patients with BM, with 51.5% dying as a result. Among the patients who underwent intracranial response assessment, 4.8% achieved complete response, 19.0% had partial response, 9.5% had stable disease, and 66.7% had disease progression. The median duration of intracranial response was 5.3 months, with an objective response rate of 23.8%. No significant differences were found in overall survival or progression-free survival between patients with and without BM. However, patients with more than 3 BM had inferior survival outcomes compared to those with fewer metastases.<br /><br />The study highlights the need for inclusion of ES-SCLC patients with BM in clinical trials involving ICIs. It also suggests further exploration of the role of prophylactic cranial irradiation and corticosteroids in combination with ICIs in ES-SCLC patients. The limitations of the study include the lack of consideration for patient outcomes after switching to second or third-line therapy following progression on ICIs, and the need for larger and more diverse populations for multivariable analysis.<br /><br />Overall, the study provides real-world evidence supporting the use of ICIs in ES-SCLC patients with BM and emphasizes the importance of including these patients in future clinical trials.

Asset Subtitle

Yuanzhen Cao

Meta Tag

Speaker Yuanzhen Cao

Topic SCLC & Neuroendocrine Tumors: First Line Therapy

Keywords

immune checkpoint inhibitors

extensive stage small-cell lung cancer

brain metastases

clinical trials

disease response

intracranial disease

atezolizumab

carboplatin

etoposide

prophylactic cranial irradiation