The following is a summary of “Efficacy and safety of thoracic radiotherapy in extensive-stage small-cell lung cancer patients receiving first-line immunotherapy plus chemotherapy: a propensity score matched multicentre retrospective analysis,” published in the February 2024 issue of Oncology by Yao et al.
Combining platinum-etoposide chemotherapy with immune checkpoint inhibitors (ICIs) stands as the established first-line standard of care for extensive-stage small-cell lung cancer (ES-SCLC). Despite this regimen’s efficacy, the impact of thoracic radiotherapy (TRT) remains uncertain in these patients. This study sought to meticulously assess TRT’s efficacy and safety profile in ES-SCLC patients who exhibited positive responses to first-line ICIs and chemotherapy (CHT).
This retrospective analysis included 276 patients receiving 4 to 6 cycles of ICIs and CHT as first-line therapy across three hospitals from 2018 to 2022. Subsequently, the cohort was segregated into two groups based on TRT receipt, followed by propensity score matching (PSM) to ensure balanced group characteristics. The study’s primary endpoints encompassed overall survival (OS) and progression-free survival (PFS), while secondary objectives included toxicity effects assessment.
Following PSM, 197 patients were eligible for further analysis, with 99 receiving TRT. The TRT and non-TRT groups demonstrated well-balanced baseline characteristics. Notably, significant disparities in PFS were observed between the TRT and non-TRT cohorts, with median PFS durations of 10.76 and 7.63 months, respectively (P = 0.014). Furthermore, a marked improvement in OS was evident in the TRT group (21.67 vs. 16.6 months, P = 0.009). Multivariate analysis underscored TRT utilization as an independent prognostic indicator for PFS and OS in ES-SCLC patients receiving ICIs plus CHT. Safety evaluations revealed no significant escalation in adverse events (AEs), with manageable incidences of radiation esophagitis and gastrointestinal and hematologic toxicities in the TRT group. However, a heightened incidence of pneumonitis was associated with high-dose radiotherapy.
The adjunctive use of TRT conferred notable survival benefits with favorable tolerability in ES-SCLC patients undergoing platinum-etoposide CHT and ICIs. These findings advocate for TRT incorporation as a viable first-line treatment strategy in the ES-SCLC setting, warranting consideration in clinical decision-making processes.
Source: ro-journal.biomedcentral.com/articles/10.1186/s13014-024-02420-x