Original Study|Articles in Press

Chemoimmunotherapy as The First-Line Treatment for Patients with Extensive-Stage Small-Cell Lung Cancer and an ECOG Performance Status of 2 or 3



      Studies demonstrated that chemoimmunotherapy prolongs progression-free survival (PFS) and overall survival (OS) in patients with extensive-stage small-cell lung cancer (ES-SCLC) and an Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0 or 1. However, there is little data regarding chemoimmunotherapy in patients with ES-SCLC and an ECOG PS 2 or 3. This study aims to evaluate the benefits of chemoimmunotherapy compared to chemotherapy in the first-line treatment of patients with ES-SCLC and ECOG-PS 2 or 3.


      This retrospective study analyzed 46 adults seen at Mayo Clinic between 2017-2020 with de novo ES-SCLC and an ECOG-PS 2 or 3. Twenty patients received platinum-etoposide and 26 patients received platinum-etoposide and atezolizumab. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier methods.


      There was no statistically significant difference in the overall survival between the chemoimmunotherapy and chemotherapy group (9.3 months [95% confidence interval: 4.9-12.8] vs 7.6 months [0.6-11.9], respectively; p = 0.21). PFS was longer in the chemoimmunotherapy group compared to the chemotherapy group (4.1 months [3.8-6.9] vs 3.2 months [0.6-4.8], respectively; p = 0.0491).


      Patients with ES-SCLC and an ECOG of 2 or 3 who received chemoimmunotherapy had a longer PFS compared to patients who received chemotherapy. While there was no difference in OS between the two treatment groups, this may be due to the small study size and thus lack of power of the study. Further research with a larger study size is needed to evaluate the potential benefit of chemoimmunotherapy on the OS.
      Prior studies have demonstrated that chemoimmunotherapy, compared to chemotherapy, prolongs PFS and OS in patients with ES-SCLS and an ECOG-PS of 0 or 1 but have excluded patients with an ECOG-PS of 2-3. This study shows that chemoimmunotherapy prolongs PFS in patients with ES-SCLC and an ECOG of 2 or 3, and so clinicians should consider chemoimmunotherapy for these patients.



      extensive-stage small-cell lung cancer ((ES-SCLC)), progression-free survival ((PFS)), overall survival ((OS)), Eastern Cooperative Oncology Group performance status ((ECOG-PS)), etoposide and platinum-based therapy ((EP)), programmed death-ligand 1 ((PD-L1) and its receptor), programmed cell death protein 1 ((PD-1)), standard deviations ((SD))
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