WCLC 2025 - Posters & ePosters-EP.13.18 Retrospective Evaluation of the Prognostic Impact of Anti-PD-L1 Antibodies in ECOG-PS 2-3 Patients With Extensive-Stage SCLC

EP.13.18 Retrospective Evaluation of the Prognostic Impact of Anti-PD-L1 Antibodies in ECOG-PS 2-3 Patients With Extensive-Stage SCLC

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This retrospective study from Saitama Medical University evaluated the prognostic impact of adding anti-PD-L1 immune checkpoint inhibitors (ICIs) to conventional chemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC) who have poor general condition, specifically those with an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 2-3. While prior pivotal trials (IMpower133 and CASPIAN) showed survival benefits of ICIs added to chemotherapy, these included only patients with good performance status (ECOG-PS 0-1), leaving efficacy unclear in poorer condition patients.<br /><br />The study included 74 ES-SCLC patients treated between 2019 and 2022, split into 42 receiving chemotherapy alone and 32 receiving chemotherapy plus anti-PD-L1 antibodies (atezolizumab or durvalumab). Patients receiving ICIs were younger on average. Multivariate analysis showed that good ECOG-PS and tumor response (complete or partial) correlated with longer overall survival (OS), while ICI administration was the only factor significantly associated with improved objective response rate (ORR).<br /><br />Notably, the median OS was significantly prolonged in the ECOG-PS 2-3 subgroup treated with ICIs (448 vs. 169 days, p=0.00661), whereas no significant OS difference was observed in ECOG-PS 0-1 patients. Additionally, ORR was markedly improved among ECOG-PS 2-3 patients receiving ICIs (93.3% vs. 56.3%, p=0.0226), indicating better tumor response correlating with survival benefit in poorer performance status patients. Age was identified as a potential confounder in ICI treatment decisions.<br /><br />In conclusion, the addition of anti-PD-L1 antibodies to first-line chemotherapy improves tumor response and prolongs survival in ES-SCLC patients with poor general condition (ECOG-PS 2-3), supporting consideration of ICIs even in this traditionally underrepresented subgroup. This study fills an important evidence gap by suggesting that ICIs provide meaningful benefit beyond patients with good performance status.

Asset Subtitle

Kosuke Sakai

Meta Tag

Speaker Kosuke Sakai

Topic Small Cell Lung Cancer and Neuroendocrine Tumors

Keywords

extensive-stage small cell lung cancer

ES-SCLC

anti-PD-L1 immune checkpoint inhibitors

ICIs

chemotherapy

ECOG performance status

poor general condition

overall survival

objective response rate

tumor response