Overall Survival According to Systemic and Radiation Treatment Approaches in Metastatic Non-Small-Cell Lung Cancer: A National Cancer Database Analysis

The role of prophylactic cranial irradiation (PCI) and thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer remains controversial. The authors examined the National Cancer Database and identified patients with extensive-stage small cell lung cancer with no brain metastasis. Patients were excluded if they died 30 days from diagnosis, did not receive polychemotherapy, had other palliative radiation or had missing information. A propensity score-matched analysis was also performed. A total of 21,019 patients were identified. The majority of patients did not receive radiation (69%), whereas 10% received PCI and 21% received TRT. The addition of PCI and TRT improved median survival and survival at 1 and 2 years (p ≤ 0.05). The propensity score-matched analysis confirmed the same overall survival benefit with both PCI and TRT. This registry-based analysis of >1500 accredited cancer programs shows that PCI and TRT are not commonly utilized for extensive-stage small cell lung cancer patients who are treated with multiagent chemotherapy. The addition of PCI and TRT significantly improves overall survival in this otherwise poor prognostic group. Further research is needed to confirm the role of PCI and TRT, especially in the era of improved systemic therapy.

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Effect of immunotherapy on overall survival in limited-stage small cell lung carcinoma: a national cancer database analysis

Therapeutic Advances in Medical Oncology ◽

10.1177/1758835920982806 ◽

2021 ◽

Vol 13 ◽

pp. 175883592098280

Author(s):

Nadeem Bilani ◽

Evan Alley ◽

Leah Elson ◽

Zeina Nahleh ◽

Rafael Arteta-Bulos

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

National Database ◽

National Cancer Database ◽

Small Cell Lung ◽

Limited Stage ◽

The Impact

Background: While immune-based therapies have been approved for extensive-stage small cell lung cancer, there is limited data on the efficacy of immunotherapy in patients with limited-stage disease. Methods: We used the National Cancer Database to first evaluate factors associated with the inclusion of immunotherapy as part of the initial therapeutic course in patients diagnosed with limited-stage small cell lung cancer (LS-SCLC). Consequently, we evaluated the impact of this immunotherapy on 2-year and 5-year overall survival (OS). We did this by performing 1:1 matching for controls that did not receive immunotherapy, and comparing survival between cohorts using the Kaplan–Meier method. Results: A total of 98 patients with LS-SCLC received immunotherapy as part of their initial therapeutic regimen. Age and facility type were the only significant predictors of the use of immunotherapy. There was no statistically significant difference between matched case-control cohorts in median OS ( p = 0.985), 2-year OS ( p = 0.747), and 5-year OS ( p = 0.934). Conclusion: In this study using a large national database, we found that the inclusion of immunotherapy as part of the initial systemic therapy regimen was not significantly associated with improved OS in a cohort of LS-SCLC patients.

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