scholarly journals Real World Analysis of Small Cell Lung Cancer Patients: Prognostic Factors and Treatment Outcomes

2021 ◽  
Vol 28 (1) ◽  
pp. 317-331
Author(s):  
Sarah Sharman Moser ◽  
Jair Bar ◽  
Inna Kan ◽  
Keren Ofek ◽  
Raanan Cohen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Real World ◽  
Treatment Patterns ◽  
Small Cell ◽  
Multivariable Model ◽  
Small Cell Lung ◽  
Limited Stage ◽  
Extensive Stage

In this observational study, we assessed treatment patterns and prognostic factors in patients with small cell lung cancer (SCLC) in a large state-mandated healthcare organization in Israel. Methods: All incident cases with histologically confirmed SCLC who initiated systemic anti-cancer treatment between 2011 and 2017 were identified. Treatment patterns and overall survival (OS) were evaluated for each line of therapy. Results: A total of 235 patients were identified (61% male, median age 64 years, 95% ever smokers, 64% had extensive stage). The first-line treatment was platinum–etoposide regimen for 98.7% of the cohort. The second and third-line regimen were given to 43% and 12% of patients, respectively. Mean OS for extensive and limited stage patients was 9.1 and 23.5 months respectively. In a multivariable model, increased risk for mortality was observed among patients with an ECOG performance status (PS) of 2 compared to a PS of 0–1 for the extensive stage patients (Hazard ratio (HR) = 1.63, 95% confidence ratios (CI): 1.00–2.65); and for males compared to females for the limited stage patients (HR = 2.17; 95% CI: 1.12–4.20). Regarding all 2nd line patients in a multivariable model incorporating relevant confounding factors, demonstrated a significantly better outcome with platinum–based regimens compared to topotecan. Median survival after initiation of 2nd line in platinum-sensitive patients was longer (p = 0.056) for those re-challenged with platinum–based regimen (n = 7): 6.8mo (6.1-not reported (NR)), compared with those switched to a different treatment (n = 27): 4.5 mo (2.6–6.6) for extensive stage patients, and a non-significant difference was also observed for limited stage patients. Conclusion: To our knowledge, this is one of the largest real-world studies of SCLC patients. OS for SCLC patients was similar to that reported in clinical trials. PS for extensive stage patients and sex for limited stage patients were significant correlates of prognosis. Re-challenge of the platinum–based doublet was associated with longer OS compared to switching treatment in extensive stage patients.

Treatment patterns in extensive-stage small cell lung cancer: A retrospective real-world data study.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 288-288
Author(s):  
Apar Kishor Ganti ◽  
Kenan Katranji ◽  
Brian S. Seal ◽  
Lance Brannman
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Real World ◽  
Standard Of Care ◽  
Treatment Patterns ◽  
Small Cell ◽  
Small Cell Lung ◽  
Real World Data ◽  
Extensive Stage

288 Background: Etoposide plus platinum-based chemotherapy (EP) was the first-line (1L) extensive stage small cell lung cancer (ES-SCLC) standard of care for many years. 1L treatment with immunotherapy (durvalumab or atezolizumab) combined with carboplatin (durvalumab, atezolizumab) or cisplatin (durvalumab) chemotherapy (CT) is now being accepted as the new standard of care in this population. This study used real-world data to describe treatment patterns of ES-SCLC patients in the United States following the introduction of immunotherapy (IO). Methods: Data for patients ≥18 years of age with an index ES-SCLC treatment from 17 October 2018 to 30 November 2019 (or no 1L treatment within 60 days of an index diagnosis during this period) were drawn from the Flatiron electronic medical records database. Proportions of patients receiving specific 1L and second-line (2L) treatments were calculated. Times from (a) index diagnosis to 1L start, (b) 1L start to 1L end (c) 1L start to 2L start, and (d) 2L start to 2L end were calculated with 95% confidence intervals (for sample sizes ≥ 30) for the CT and IO+CT treatment categories. Results: 568 patients met the inclusion/exclusion criteria: 77 (14%) were untreated 60 days after their index diagnosis; 491 received 18 different 1L treatments (1L CT: 195; 1L IO+CT: 286, other 1L therapy: 10); and 119 received 2L treatment following 1L CT or IO+CT. The table shows the most frequently occurring 1L and 2L treatments. The mean number of days [#patients, 95% confidence interval] for 1L CT and 1L IO+CT respectively were (a) index diagnosis to 1L start: 22 [194 (1 patient began 1L therapy prior to their index diagnosis); 20–26], 22 [286, 20–24]; (b) 1L start to 1L end: 58 [174, 52–66], 91 [125, 79–103]; (c) 1L start to 2L start: 115 [83, 99–133], 186 [36, 168–205]; (d) 2L start to 2L end: 55 [54, 42–69] and 36 [N = 21]. Conclusions: Most ES-SCLC patients started therapy within a month of diagnosis. Over 50% received 1L IO+CT, reflecting its rapid uptake in the US. Almost 14% patients did not receive 1L treatment and only ~25% of 1L CT and 1L IO+CT patients received 2L therapy within the study period; reasons for this warrant further investigation. [Table: see text]

Outcome of patients with small-cell lung cancer: effect of changes in staging procedures and imaging technology on prognostic factors over 14 years.

1990 ◽  
Vol 8 (6) ◽  
pp. 1042-1049 ◽  
Author(s):  
M P Dearing ◽  
S M Steinberg ◽  
R Phelps ◽  
M J Anderson ◽  
J L Mulshine ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cox Proportional Hazards ◽  
Small Cell ◽  
Small Cell Lung ◽  
Limited Stage ◽  
The Impact

In a study of 411 patients with small-cell lung cancer (SCLC) entered on therapeutic clinical trials between 1973 and 1987, we analyzed whether changes in the prognostic importance of pretreatment factors had occurred during the 14-year time period. After adjusting for other prognostic factors, brain involvement was associated with shorter survival in patients treated before December 1979 (P = .024) but not in patients treated thereafter (P = .54). The patients diagnosed before 1979 had brain metastases documented by radionuclide scan while computed cranial tomography (CCT) was more commonly used after 1979. Patients who had brain metastases diagnosed by radionuclide scan lived a shorter period of time than patients who had the diagnosis made by the more sensitive CCT scan (P = .031). In contrast, Cox proportional hazards modeling showed that liver metastases in patients were associated with shorter survival in patients treated after 1979 (P = .0007) but not in patients treated before then (P = .30). A larger proportion of patients had a routine liver biopsy before 1979 than after 1979 when more patients had the liver staged with less sensitive imaging studies and biochemical parameters. Patients with SCLC whose cancer was confined to the thorax but had medical or anatomic contraindications to intensive chest radiotherapy had similar survival compared with patients with limited-stage SCLC who were treated with combination chemotherapy alone (P = .68). From these data we conclude: (1) the sensitivity of the staging procedures used can affect the impact on survival of cancer involvement of a given site; and (2) patients with cancer confined to their chest with medical or anatomic contraindications to chest radiotherapy do not have a shorter survival than patients with limited-stage disease treated with chemotherapy alone.

scholarly journals Front Line Applications and Future Directions of Immunotherapy in Small-Cell Lung Cancer

Cancers ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 506
Author(s):  
Selina K. Wong ◽  
Wade T. Iams
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Limited Stage ◽  
Extensive Stage

After being stagnant for decades, there has finally been a paradigm shift in the treatment of small-cell lung cancer (SCLC) with the emergence and application of immune checkpoint inhibitors (ICIs). Multiple trials of first-line ICI-chemotherapy combinations have demonstrated survival benefit compared to chemotherapy alone in patients with extensive-stage SCLC, establishing this as the new standard of care. ICIs are now being applied in the potentially curative limited-stage setting, actively being investigated as concurrent treatment with chemoradiation and as adjuvant treatment following completion of chemoradiation. This review highlights the evidence behind the practice-changing addition of ICIs in the first-line setting of extensive-stage SCLC, the potentially practice-changing immunotherapy trials that are currently underway in the limited-stage setting, and alternate immunotherapeutic strategies being studied in the treatment of SCLC.

Limited Stage Small Cell Lung Cancer: Analysis of Clinical Prognostic Factors

1987 ◽  
Vol 80 (12) ◽  
pp. 1518-1522 ◽  
Author(s):  
JOHN D. HAINSWORTH ◽  
DAVID H. JOHNSON ◽  
ROBERT V. FARESE ◽  
JODY W. MACEY ◽  
WILLIAM K. VAUGHN ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Limited Stage

scholarly journals OTHR-15. PATIENTS WITH LIMITED STAGE SMALL CELL LUNG CANCER THAT RECUR WITH ISOLATED BRAIN METASTASES HAVE PROLONGED SURVIVAL

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i21-i21
Author(s):  
Bryan Bonder ◽  
Fatemeh Ardeshir Larijani ◽  
Afshin Dowlati ◽  
Lisa Rogers
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Small Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Limited Stage ◽  
Stage Disease ◽  
Extensive Stage ◽  
Metastatic Sites ◽  
The Brain

Abstract INTRODUCTION: Small cell lung cancer (SCLC) frequently metastasizes to the brain. In patients with limited-stage disease (disease confined to one radiation portal), the incidence of brain metastasis after 3 years is 50–60%. We reviewed patients with SCLC and hypothesized that isolated brain recurrence has a unique natural history. METHODS: 471 adult SCLC patients seen at University Hospitals Case Medical Center from 1998 to 2014 were screened. Patients were separated by those with isolated brain metastases and those with other patterns of metastasis. Demographic data including age, race, sex, smoking history and clinical data such as TNM classification, stage, treatment, and time to relapse and death were collected. Median overall survival (mOS) and progression free survival (mPFS) were compared using log-rank tests and Kaplan-Meier plots were constructed. In a separate cohort of metastatic SCLC we examined differences in next generation sequencing (NGS) of targeted exomes between primary and metastatic sites including the brain. RESULTS: 281 extensive-stage patients and 40 limited-stage patients were included. 12% (30/281) of the extensive-stage patients and 25% (10/40) of limited-stage patients had isolated brain metastases. Patients with limited-stage disease who developed isolated brain metastases had significantly improved mOS as compared to those who developed other sites of metastasis (OS = 38.7 months vs. 20.2 months, p=0.033). Furthermore, mPFS for limited-stage patients with isolated brain metastases was improved compared to other patterns of metastases (PFS = 17.9 months vs. 10.1 months, p = 0.03). NGS demonstrated that NOTCH1 mutations were infrequent in biopsies from all metastatic sites but were common in primary lung tumors. CONCLUSION: In our single center review, patients with limited-stage SCLC who recurred only in the brain had improved survival as compared to those who had other patterns of metastases. Our initial work demonstrates differences in oncogenic gene mutations between the metastatic and primary tumors.

scholarly journals Mining prognostic factors of extensive-stage small-cell lung cancer patients using nomogram model

Medicine ◽  
2020 ◽  
Vol 99 (33) ◽  
pp. e21798
Author(s):  
Hongxiang Gao ◽  
Yazheng Dang ◽  
Tao Qi ◽  
Shigao Huang ◽  
Xiaozhi Zhang
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Small Cell Lung Cancer ◽  
Cancer Patients ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Lung Cancer Patients ◽  
Extensive Stage
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