| Objective:The addition of PD-L1 to chemotherapy significantly prolonged progressionfree survival compared to chemotherapy alone in the first-line treatment of extensive smallcell lung cancer,but real-world data are still lacking.In addition,most patients in the real world choose more than 4 cycles of chemotherapy in induction phase.The impact of the number of induction phase chemotherapy cycles is still not known.Our study aims to explore the efficacy and safety of first-line use PD-L1 for extensive small-cell lung cancer in the real world.Methods:Patients diagnosed with extensive-stage small-cell lung cancer between May 2016 and May 2021 were enrolled in this retrospective analysis from seven hospitals in China.This study was grouped according to the patients whether or not use atezolizumab.Patients use atezolizumab for four to six 21-day cycles(induction phase),followed by a maintenance phase during which they received either atezolizumab until they had unacceptable toxic effects,disease progression according to Response Evaluation Criteria in Solid Tumors,version 1.1,or no additional clinical benefit.Propensity score matching was performed for age,sex,smoking history,family history of cancer,hepatic metastases,brain metastasis,bone metastasis,pleural metastasis in a 1:1 ratio between the two group.Further,the effects of atezolizumab on progression-free survival with extensive-stage small-cell lung cancer were examined.Cox regression analysis was applied to predict the factors that influenced the progression-free survival of extensive-stage small-cell lung cancer.Results:Overall,149 extensive-stage small-cell lung cancer patients,including 93(62.4%)only use chemotherapy and 56(37.6%)used PD-L1 plus chemotherapy,were included.Among them,40 patients(71.4%)received atezolizumab and 16 patients(28.6%)received durvalumab.The two comparison cohorts were matched by 1:1 propensity score,and 34 matched pairs of patients with extensive stage small cell lung cancer were obtained.The median follow-up time was 22.7 months.The median progression-free survival was 7.53 months in the immunotherapy group and 6.47 months in the control group.The overall survival time was 17.47 months in the immunotherapy group and 13.73 months in the control group.Treatment with induction cycles greater than 4 cycles was associated with a reduced risk of disease progression compared to treatment with induction cycles less than or equal to 4 cycles(HR=0.581;95%confidence interval[CI],0.411-0.820;P=0.012),but no effect on overall survival.Among 56 patients in the immunotherapy group,36 patients continued immune maintenance therapy after receiving induction chemotherapy.The progression-free survival of patients receiving immune maintenance therapy was longer than those who did not receive immune maintenance therapy(9.37 months and 5.1 months),and the overall survival was also longer(18.2 months and 15.63 months).In the immunotherapy group,53 patients could be evaluated,the objective response rate was 69.64%,and the disease control rate was 92.86%.No immune-related adverse events resulted in death.There were 13 patients(23.21%)with immune-related adverse events.A total of 46 patients in the immunotherapy group stopped treatment for different reasons.The mean duration of immunotherapy was 9.73 months.Conclusions:In the real world,immunotherapy combined with PD-L1 in the first-line treatment of extensive small cell lung cancer significantly prolonged progression-free survival and overall survival.Compared with treatment with a number of induction cycles less than or equal to 4 cycles,induction cycles greater than 4 cycles were associated with a reduced risk of disease progression,but had no effect on overall survival.Continued immune maintenance therapy after first-line immunotherapy combined with standard chemotherapy prolonged progression-free survival and overall survival.Changes in the values of tumor markers CFA21-1,NSE,CEA and pro-GRP can reflect whether the disease progresses.Background:For half a century,although first-line chemotherapy combined with immunotherapy can prolong the overall survival of patients with extensive small-cell lung cancer,the efficacy is not satisfactory,especially whether maintenance therapy after firstline standard chemotherapy is still inconclusive.Extensive stage small cell lung cancer progresses rapidly,and follow-up treatment options after first-line treatment are limited.How to delay disease progression and prolong overall survival of patients with small cell lung cancer after initial chemotherapy is a clinical problem.In recent years,low-dose oral multi-target drugs,such as Apatinib,have played a good role in the treatment of small cell lung cancer.Methods:Twelve patients with extensive small cell lung cancer were included in this study to investigate the efficacy and toxicity of Apatinib in maintenance therapy after standard first-line chemotherapy for extensive small cell lung cancer.The primary end points were progression-free survival and overall survival.Secondary endpoints include toxicity and safety.In patients with extensive small-cell lung cancer,a maintenance therapy of 250mg/day of Apatinib was administered once daily after 4-6 cycles of standard chemotherapy until progression,death,or toxicity intolerance occurred.Results:The median PFS of patients receiving Apatinib maintenance therapy was 3.7 months(95%CI:1.3-6.2 months).Median OS was 16.3 months(95%CI:9.7-22.8 months).The objective effective rate and disease control rate were 50.0%and 66.7%.Dose reduction(to 250mg every other day)was required in 2 patients due to adverse reactions.The most common adverse events included hypertension(n=4,33.3%)and hand and foot skin reactions(n=2,16.7%).One patient developed diarrhea and the other coughed up blood.The most serious adverse reaction was intestinal obstruction.Conclusion:Apatinib maintenance therapy has good curative effect and can prolong progression-free survival and overall survival in patients with extensive small-cell lung cancer,so as to be an effective treatment in future clinical practice.However,given the small sample size of this study,future studies with a large sample size are needed to verify the findings of this study.Background:Females differ from males in several epidemiological,hormonal,and clinical characteristics,resulting in a different prognosis for small cell lung cancer(SCLC).This study aimed to summarize the clinicopathological features,prognosis,and treatment of female SCLC in the clinic.Methods:The study collected data from our cancer center from May 1,2015,to April 1,2020.Eligible female patients required histological or cytological confirmation of SCLC.All tests in this study were bilateral tests,and p<0.05 was considered statistically significant.Results:Among 89 patients,the 1-year,3-year,and 5-year overall survival(OS)rates were 84.21%,39.76%,and 18.56%,respectively.The 1-year,2-year,and 3-year progressionfree survival(PFS)rates were 42.7%,21.71%,and 13.23%,respectively.In the whole cohort,the median PFS was 10 months(range 8.03-11.97 months),the median OS was 34 months(range 26.6-41.4 months).As of February 1,2020,45 patients had died and 44 patients were still alive.The prognosis of limited-stage small cell lung cancer(LD-SCLC)was better than that of extensive-stage small cell lung cancer(ED-SCLC).The mPFS of LD-SCLC and the ED-SCLC was 10 months(3.71-16.29 months)and 9 months(7.0910.91 months),respectively.Conclusion:The survival of female patients with SCLC was longer than that of male patients regardless of stages.Chest radiotherapy and prophylactic brain irradiation are necessary for the effective treatment of SCLC in women. |
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