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. 2022 Aug 30;34(4):353-364.
doi: 10.21147/j.issn.1000-9604.2022.04.04.

Clinical outcomes of atezolizumab in combination with etoposide/platinum for treatment of extensive-stage small-cell lung cancer: A real-world, multicenter, retrospective, controlled study in China

Hanxiao Chen  1 , Xiangjuan Ma  2 , Jie Liu  3 , Yu Yang  4 , Yong Fang  5 , Liping Wang  6 , Jian Fang  2 , Jun Zhao  1 , Minglei Zhuo  1
Affiliations

Clinical outcomes of atezolizumab in combination with etoposide/platinum for treatment of extensive-stage small-cell lung cancer: A real-world, multicenter, retrospective, controlled study in China

Hanxiao Chen et al. Chin J Cancer Res. .

Abstract

Objective: Atezolizumab along with chemotherapy has prolonged the survival of patients with extensive-stage small-cell lung cancer (ES-SCLC) worldwide, although real-world (RW) data are lacking in China. This study was designed to evaluate the efficacy and clinical outcomes of atezolizumab plus etoposide/platinum (EP).

Methods: Data obtained in this retrospective study were captured from six oncology units of five medical facilities from January 2019 to April 2022. For first-line treatments, atezolizumab combined with EP vs. EP alone, we primarily evaluated progression-free survival (PFS); other efficacy indicators, including overall survival (OS), objective response rate (ORR), and patterns of SCLC progression and adverse events (AEs) were assessed.

Results: The primary analysis included data from 225 patients, of whom 133 received EP along with atezolizumab (atezolizumab group) and 92 received EP alone (EP group). The PFS duration of the atezolizumab group [7.10 months; 95% confidence interval (95% CI), 6.53-9.00] exceeded that of the EP group (6.50 months; 95% CI, 4.83-7.53). Overall, the hazard ratio (HR) was 0.69 (95% CI, 0.49-0.97) (P=0.029); particularly, the HR was 0.54 (95% CI, 0.36-0.80) among patients undergoing ≥4 chemotherapy cycles and 0.33 (95% CI, 0.20-0.56) among individuals with atezolizumab maintenance. The ORR and disease-control rate (DCR) were similar between the two groups. Because of incomplete OS data, the median OS was not determined for either group. Bone marrow suppression was the most common AE detected (58.6%) in the atezolizumab group. Immune-related AEs occurred in 19 patients in the atezolizumab group (14.3%), with only one case of grade 3 encephalitis.

Conclusions: This RW study in China demonstrated improved clinical outcomes of atezolizumab along with EP for ES-SCLC, particularly in the chemosensitive population. These results align with the results of the IMpower133 study, although the impact of this treatment modality on OS warrants additional follow-up studies.

Keywords: Real-world study; atezolizumab; extensive-stage SCLC.

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Figures

Figure 1
Figure 1
Eligibility and analysis. ES-SCLC, extensive-stage small-cell lung cancer.
Figure 2
Figure 2
Investigator-assessed PFS. Kaplan-Meier analysis of PFS outcomes in patients treated with EP+A compared with those in patients treated with EP alone for all patients (HR=0.69, 95% CI, 0.49−0.97, P=0.029) (A), chemosensitive patients (HR=0.54, 95% CI, 0.36−0.80, P=0.002) (B) and maintenance population (HR=0.33, 95% CI, 0.20−0.56, P<0.001) (C). EP, etoposide and platinum; EP+A, atezolizumab plus EP; PFS, progression-free survival; HR, hazard ratio; 95% CI, 95% confidence interval.
Figure 3
Figure 3
PFS subgroup analysis. Subgroup analysis of PFS according to baseline and treatment characteristics. †, patients with brain metastases; PFS, progression-free survival; TCI, therapeutic cranial irradiation; PCI, prophylactic cranial irradiation; EP, etoposide and platinum; EP+A, atezolizumab plus EP; HR, hazard ratio; 95% CI, 95% confidence interval.
Figure 4
Figure 4
Progression patterns. Pie chart of progression patterns among patients with disease progression or death in the EP+A (n=71) and EP (n=67) groups. Blue, one site of disease progression (oligo-progression); orange, more than or equal to two sites of disease progression; grey, site of progression is unknown; EP, etoposide and platinum; EP+A, atezolizumab plus EP.
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