Role of chest radiation in extensive-stage small cell lung cancer with ipsilateral pleural effusion.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20567-e20567
Author(s):  
Takefumi Komiya ◽  
Emily Powell ◽  
Charles Vu ◽  
Shinkichi Takamori
Keyword(s):  
Lung Cancer ◽  
Pleural Effusion ◽  
Small Cell Lung Cancer ◽  
Survival Benefit ◽  
Multivariate Analyses ◽  
Small Cell ◽  
Hazard Ratio ◽  
Small Cell Lung ◽  
Extensive Stage

e20567 Background: Prognosis of extensive-stage small cell lung cancer (ES-SCLC) remains poor. Previous randomized trials suggested consolidation chest radiation (CXRT) has a modest survival benefit; however, its role in subgroups of ES-SCLC, especially ipsilateral pleural effusion (IPE) have not been reported and unknown. Methods: Using National Cancer Database (NCDB), 283,347 ES-SCLC cases diagnosed between 2004 and 2017 were screened. Eligible cases must have been staged with 7th edition of staging system and have information about clinical T and N stage, and minimum follow-up of one month. Role of CXRT was examined in M1a, M1b, and IPE subgroups. Surveillance, Epidemiology, and End Results Program (SEER) was analyzed to independently validate our results. Univariate and multivariate analyses were conducted with Cox proportional hazard models. A p-value < 0.05 was considered as statistically significant. Results: A total of 36,762 (5,511 with M1a, 31,251 with M1b, and 2,013 with IPE) cases were analyzed. In both M1a and IPE groups, use of CXRT was significantly associated with younger age, female sex, non-academic institution, and clinical T stage. Both univariate and multivariate analyses showed that use of CXRT demonstrated significantly longer overall survival in all the groups, with lower hazard ratios in the M1a and IPE groups than in the M1b group (univariate hazard ratio 0.62, 0.56, and 0.72, respectively). Propensity score analysis of the IPE group also showed a survival advantage in the CXRT group (hazard ratio 0.54). The SEER data also showed a survival advantage of CXRT in the IPE group (univariate hazard ratio of 0.40). Conclusions: This retrospective database analysis suggests M1a and in particular IPE subgroups have more survival benefit of CXRT than the M1b subgroup. Further studies are warranted to confirm the hypothesis.

Use of prophylactic cranial irradiation in patients with extensive-stage small cell lung cancer receiving immunotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19309-e19309
Author(s):  
Daniel X. Yang ◽  
Vikram Jairam ◽  
Henry S. Park ◽  
Roy H. Decker ◽  
Anne C. Chiang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Survival Benefit ◽  
Cranial Irradiation ◽  
Prophylactic Cranial Irradiation ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Extensive Stage

e19309 Background: Prophylactic cranial irradiation (PCI) use is controversial in extensive-stage small cell lung cancer (ES-SCLC). In addition to lack of survival benefit of PCI compared to close MRI surveillance in a 2017 published trial, the role of PCI is being further challenged in the modern immune-oncology (IO) era. The IMpower133 trial reporting a survival benefit to atezolizumab for ES-SCLC published in 2018 did not require PCI use. Contemporary practice patterns of PCI in relation to immunotherapy are unknown. Methods: We performed a retrospective cohort analysis of patients with ES-SCLC diagnosed between January 1, 2013 to September 31, 2019 from the nationwide Flatiron Health electronic health record-derived de-identified database. First-line chemotherapy (Chemo) was defined as Chemo given alone, while first-line IO therapy was IO alone or combined with chemotherapy as initial systemic therapy. Results: The cohort included 3047 ES-SCLC patients who received first-line Chemo, and 324 patients who received first-line IO. For first-line IO patients, 268 (82.7%) received first-line atezolizumab. The use of first-line IO increased from 1.2% of patients diagnosed in 2013 to 11.3% of patients diagnosed in 2018 (p < 0.001), and 54.5% of patients diagnosed in 2019 (p < 0.001). Overall documented PCI for patients receiving either first-line IO or first-line Chemo decreased from 14.7% in 2013 to 7.0% in 2018-2019 (p < 0.001). For first-line IO patients, 23 (7.1%) had documented PCI over our study period, with 5.3% of patients diagnosed in 2018-2019 having received PCI. In contrast, for first-line Chemo patients, 428 (14.0%) received PCI over our study period, and PCI use significantly decreased from 14.8% in 2013 to 7.9% in 2018-2019 (p = 0.001). In 2018-2019, use of PCI was not significantly different between patients receiving first-line IO compared to first-line Chemo (5.3% vs 7.9%, p = 0.163). Conclusions: The use of first-line IO has significantly increased in ES-SCLC. Overall PCI rates for ES-SCLC patients decreased significantly over the study period, although documented PCI use rates do not differ between patients receiving upfront IO or Chemo in 2018-2019. Further investigation is warranted regarding effectiveness of PCI in the modern IO era.

scholarly journals Role of thoracic radiotherapy in extensive stage small cell lung cancer: a systemic review and meta-analysis

2021 ◽  
Vol 9 (4) ◽  
pp. 299-299
Author(s):  
Ao-Mei Li ◽  
Han Zhou ◽  
Yang-Yang Xu ◽  
Xiao-Qin Ji ◽  
Tian-Cong Wu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Meta Analysis ◽  
Small Cell ◽  
Systemic Review ◽  
Thoracic Radiotherapy ◽  
Small Cell Lung ◽  
Extensive Stage

scholarly journals The Role of Immunotherapy in Extensive Stage Small-Cell Lung Cancer: A Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Ioanna Tsiouprou ◽  
Athanasios Zaharias ◽  
Dionisios Spyratos
Keyword(s):  
Lung Cancer ◽  
Monoclonal Antibody ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Platinum Based Chemotherapy ◽  
Response To Chemotherapy ◽  
Extensive Stage

Lung cancer is the second most common cancer in both sexes worldwide. Small-cell lung cancer (SCLC) is a form of neuroendocrine tumor, which is classified into limited and extensive-stage disease and shows excellent initial response to chemotherapy; however, almost all patients relapse later. During the past few years, several clinical trials have evaluated the effect of addition of immunotherapy to conventional chemotherapy in patients with extensive SCLC. Checkpoint inhibitors are currently under investigation, especially the CTLA-4 and PD-1/PD-L1 inhibitors. Nowadays, evidence show a statistically significant survival benefit of adding atezolizumab, an IgG1 monoclonal antibody targeting against PD-L1, to platinum-based chemotherapy plus etoposide in patients who have not received any previous systemic therapy. Furthermore, the role of nivolumab, an IgG4 anti-PD-1 monoclonal antibody, is significant for the treatment of relapsed SCLC cases. Recently, pembrolizumab was the first immunotherapeutic agent to be approved by the FDA for patients with metastatic SCLC with disease progression on or after platinum-based chemotherapy and at least one other prior line of chemotherapy. Nevertheless, prognostic biomarkers to immunotherapy response remain to be discovered.

scholarly journals Prolonging Survival: The Role of Immune Checkpoint Inhibitors in the Treatment of Extensive‐Stage Small Cell Lung Cancer

2020 ◽  
Vol 25 (11) ◽  
pp. 981-992
Author(s):  
Barbara Melosky ◽  
Parneet K. Cheema ◽  
Anthony Brade ◽  
Deanna McLeod ◽  
Geoffrey Liu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Small Cell ◽  
Small Cell Lung ◽  
Extensive Stage
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