WCLC 2025 - Posters & ePosters-EP.13.34 Meta-Analysis of First-Line Immunochemotherapy in ES-SCLC: Does ECOG PS =2 Affect Survival Outcomes

EP.13.34 Meta-Analysis of First-Line Immunochemotherapy in ES-SCLC: Does ECOG PS =2 Affect Survival Outcomes

Pdf Summary

This meta-analysis assessed the survival benefits of first-line immunochemotherapy in patients with extensive-stage small cell lung cancer (ES-SCLC) who have an Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 2, a group often underrepresented in clinical trials. Researchers systematically searched multiple databases up to March 2025, including studies that reported survival outcomes (progression-free survival [PFS] and overall survival [OS]) stratified by ECOG PS, comparing immunochemotherapy to chemotherapy alone.<br /><br />Seventeen eligible studies with a total of 3,022 ES-SCLC patients were analyzed. Approximately 20% of newly diagnosed patients had ECOG PS 2. The meta-analysis found no statistically significant differences in OS or PFS when comparing patients with ECOG PS 2 to those with better performance status (PS 0 or 1), both overall and within the subgroup receiving immunochemotherapy. Specifically, hazard ratios (HRs) for OS and PFS comparing PS 2 to PS 0/1 patients were near unity, indicating similar survival outcomes.<br /><br />Importantly, immunochemotherapy significantly improved survival outcomes compared to chemotherapy alone within the ECOG PS 2 subgroup, with an OS HR of 0.64 and a PFS HR of 0.44, demonstrating clear short- and long-term survival advantages.<br /><br />The study concludes that baseline ECOG PS 2 should not preclude ES-SCLC patients from receiving first-line immunochemotherapy, as these patients can also achieve substantial survival benefits. However, most included studies were retrospective and real-world in nature, suggesting cautious interpretation. The authors recommend further large-scale prospective trials including patients with poorer performance status to better define the efficacy and safety of immunochemotherapy in this population.

Asset Subtitle

Xinmin Yu

Meta Tag

Speaker Xinmin Yu

Topic Small Cell Lung Cancer and Neuroendocrine Tumors

Keywords

extensive-stage small cell lung cancer

ES-SCLC

ECOG Performance Status 2

immunochemotherapy

first-line treatment

progression-free survival

overall survival

meta-analysis

hazard ratio

clinical trials