Araştırma Makalesi
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Does using atezolizumab with more combination chemotherapy prolong survival in small cell lung cancer?

Yıl 2023, , 476 - 481, 30.09.2023
https://doi.org/10.18663/tjcl.1338507

Öz

Aim: For nearly 50 years, the standard first-line treatment for small cell lung cancer (SCLC) has been platinum-based chemotherapy combined with etoposide regimen. The use of atezolizumab in combination with chemotherapy in the first-line treatment of extensive-stage SCLC has recently been shown to improve survival in a randomized trial. Patients with SCLC not treated with immunotherapy received standard 6 cycles of platinum-based chemotherapy with the most effective survival results, whereas in the randomized trial of atezolizumab, standard 4 cycles of chemotherapy were administered. This retrospective study aims to present real-life data of atezolizumab combined with 6 cycles of chemotherapy in the first-line treatment of extensive-stage SCLC.
Material and Methods: The study included patients diagnosed with disseminated SCLC in our clinic who received a minimum of 6 cycles of treatment with carboplatin-etoposide plus atezolizumab in the first-line induction phase. Patients who completed the induction phase received atezolizumab 1200 mg every 3 weeks in the maintenance phase. Patients who received less than 6 cycles of chemotherapy combined with atezolizumab in the induction phase and patients with missing laboratory data were excluded from the study. Characteristics of the patients, treatments administered, response rates and survival data were analyzed. Kaplan-Meier test was used to determine survival data and the effects of metastasis sites were analyzed using log-rank test.
Results: Twenty-four patients fulfilling the criteria were included. The median age was 64 years and two thirds had comorbid disease. The median number of chemotherapy cycles was 6 (6-12) and atezolizumab cycles was 8 (6-54). After a median follow-up of 9.4 months, the median progression-free survival (PFS) and overall survival (OS) were 9.5 months (95% CI 0.0-25.8) and 30.1 months (95% CI 3.26-57.004), respectively. The overall response rate was 87.5%. There was no significant difference between the number of metastatic sites (p = 0.77) and OS. Grade 3 side effects were observed in more than half of the patients. The most common side effects were hematological toxicities, and all toxicities were manageable.
Conclusion: These real-life data confirm the efficacy and safety of atezolizumab combined with at least six cycles of chemotherapy in the induction phase in the first-line treatment of extensive-stage SCLC.

Destekleyen Kurum

HERHANGİ BİR DESTEKLEYEN KURUM YOKTUR

Teşekkür

DEĞERLENDİRMENİZ İÇİN TEŞEKKÜR EDERİM

Kaynakça

  • Byers LA, Rudin CM (2015) Small cell lung cancer: where do we go from here? Cancer 121(5):664–672
  • Oronsky B, Reid TR, Oronsky A, Carter CA. What’s New in SCLC? A Review. Neoplasia (United States) 19: 842-847, 2017.
  • Farago AF, Keane FK (2018) Current standards for clinical manage- ment of small cell lung cancer. Transl Lung Cancer Res 7(1):69
  • Pietanza MC, Byers LA, Minna JD, Rudin CM (2015) Small cell lung cancer: will recent progress lead to improved outcomes? Clin Can- cer Res 21(10):2244–2255
  • Früh M, De Ruysscher D, Popat S, Crinò L, Peters S, Felip E (2013) Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:vi99–vi105
  • Chung HC, Piha-Paul SA, Lopez-Martin J et al (2020) Pembrolizumab after two or more lines of previous therapy in patients with recurrent or metastatic SCLC: results from the KEYNOTE-028 and KEYNOTE-158 studies. J Thorac Oncol 15(4):618–627
  • Horn L, Mansfield AS, Szczęsna A et al (2018) First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 379(23):2220–2229
  • Taylor M, Antonia S, Bendell J et al. Phase I / II study of nivolumab with or without ipilimumab for treatment of recur- rent small cell lung cancer (SCLC): CA209-032. J Immunother Cancer 3: 376, 2015.
  • Paz-Ares L, Dvorkin M, Chen Y et al (2019) Durvalumab plus platinum–etoposide versus platinum– etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 394(10212):1929–1939
  • National Comprehensive Cancer Network. Neuroendocrine and Adrenal Tumors (Version 1.2019). https://www.nccn. org/professionals/physician_gls/pdf/neuroendocrine.pdf (Ac- cess date: 05/03/2020).
  • Sahin, A. B., Cubukcu, E., Birol, O. et al (2020). Chemo-immunotherapy with atezolizumab in extensive-stage small-cell lung cancer; Single-Center Experience. International Journal of Hematology and Oncology, 33(1), 148-154.
  • Gürbüz M, Kutlu Y, Akkuş E, et al (2022). Atezolizumab combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer: a real-life data of the Turkish Oncology Group. J Cancer Res Clin Oncol. 2022 Dec;148(12):3547-3555.
  • Yang F, Markovic SN, Molina JR, et al (2020) Association of sex, age, and Eastern Cooperative Oncology Group performance status with survival benefit of cancer immunotherapy in randomized clinical trials: a systematic review and meta-analysis. JAMA Netw Open 3(8):e2012534
  • Rudin CM, Awad MM, Navarro A, et al (2020) Pembrolizumab or placebo plus etoposide and platinum as first-line therapy for extensive-stage small-cell lung cancer: randomized, double-blind, phase III KEYNOTE-604 study. J Clin Oncol 38(21):2369
  • Reck, M., Liu, S. V., Mansfield, A. S., et al (2019). IMpower133: Updated overall survival (OS) analysis of first-line (1L) atezolizumab (atezo)+ carboplatin+ etoposide in extensive-stage SCLC (ES-SCLC). Annals of Oncology, 30, v710-v711.
  • Paz-Ares, L., Goldman, J. W., Garassino, M. C., et al(2019). PD-L1 expression, patterns of progression and patient-reported outcomes (PROs) with durvalumab plus platinum-etoposide in ES-SCLC: results from CASPIAN. Annals of Oncology, 30, v928-v929.
  • Nesbit EG, Leal TA, Kruser TJ. What is the role of radiotherapy for extensive-stage small cell lung cancer in the immuno- therapy era? Transl Lung Cancer Res 8: 153-162, 2019.

Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?

Yıl 2023, , 476 - 481, 30.09.2023
https://doi.org/10.18663/tjcl.1338507

Öz

Amaç: Küçük hücreli akciğer kanserinde (KHAK) yaklaşık 50 yıldır standart birinci basamak tedavi platin bazlı kemoterapi ile kombine etoposid rejimidir. Atezolizumabın yaygın evre KHAK birinci basamak tedavisinde kemoterapi ile kombine kullanımı yakın zamandan sağkalımı iyileştirdiği randomize bir çalışmada gösterilmiştir. Immunoterapi tedavisi uygulanmayan KHAK’li hastalara standart 6 kür platin bazlı kemoterapi uygulanarak en etkili sağkalım sonuçlarına ulaşılırken, atezolizumabın randomize çalışmasında standart 4 kür kemoterapi uygulanmıştır. Bu retrospektif çalışma, yaygın evre KHAK birinci basamak tedavisinde 6 kür kemoterapi ile kombine atezolizumabın gerçek yaşam verilerini sunmayı amaçlamaktadır.
Gereçler ve Yöntemler: Çalışmaya kliniğimizdeki yaygın evre KHAK tanılı ve birinci basamak indüksiyon fazında karboplatin-etoposid artı atezolizumab ile kombine minimum 6 siklus tedavi alan hastalar dahil edildi. İndüksiyon fazı tamamlanan hastalara idame fazında atezolizumab 1200 mg 3 haftada bir uygulandı. İndüksiyon fazında 6 siklus atezolizumab ile kombine kemoterapiden az tedavi alan hastalar ile laboratuvar verileri eksik olan hastalar çalışma dışı bırakıldı. Hastaların özellikleri, uygulanan tedaviler ve tedaviye yanıt oranları ile sağ kalım verileri incelendi. Sağkalımı verilerini belirlemek için Kaplan-Meier testi kullanıldı ve metastaz bölgelerinin etkileri log-rank testi kullanılarak analiz edildi.
Bulgular: Kriterleri karşılayan 24 hasta dahil edildi. Ortanca yaş 64 idi ve üçte ikisinde komorbid hastalık vardı. Medyan kemoterapi döngüsü sayısı 6 (6-12) ve atezolizumab döngüsü 8 (6-54) idi. Medyan 9,4 aylık takipten sonra medyan progresyonsuz sağkalım (PFS) ve genel sağkalım (OS) sırasıyla 9.5 ay (%95 GA 0.0-25.8) ve 30,1 aydı (%95 GA 3.26-57.004). Genel yanıt oranı %87.5 idi. Metastatik bölge sayısı (p = 0.77) ile OS arasında anlamlı bir fark bulunamadı. Hastaların yarısından fazlasında derece 3 yan etki gözlendi. En sık yan etkiler hematolojikdi ve toksisiteler yönetilebilirdi.
Sonuç: Bu gerçek yaşam verileri, yaygın evre KHAK birinci basamak tedavisinde indüksiyon fazında en az altı siklus kemoterapi ile kombine atezolizumab etkiliğini ve güvenliliğini doğrulamaktadır.

Kaynakça

  • Byers LA, Rudin CM (2015) Small cell lung cancer: where do we go from here? Cancer 121(5):664–672
  • Oronsky B, Reid TR, Oronsky A, Carter CA. What’s New in SCLC? A Review. Neoplasia (United States) 19: 842-847, 2017.
  • Farago AF, Keane FK (2018) Current standards for clinical manage- ment of small cell lung cancer. Transl Lung Cancer Res 7(1):69
  • Pietanza MC, Byers LA, Minna JD, Rudin CM (2015) Small cell lung cancer: will recent progress lead to improved outcomes? Clin Can- cer Res 21(10):2244–2255
  • Früh M, De Ruysscher D, Popat S, Crinò L, Peters S, Felip E (2013) Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24:vi99–vi105
  • Chung HC, Piha-Paul SA, Lopez-Martin J et al (2020) Pembrolizumab after two or more lines of previous therapy in patients with recurrent or metastatic SCLC: results from the KEYNOTE-028 and KEYNOTE-158 studies. J Thorac Oncol 15(4):618–627
  • Horn L, Mansfield AS, Szczęsna A et al (2018) First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med 379(23):2220–2229
  • Taylor M, Antonia S, Bendell J et al. Phase I / II study of nivolumab with or without ipilimumab for treatment of recur- rent small cell lung cancer (SCLC): CA209-032. J Immunother Cancer 3: 376, 2015.
  • Paz-Ares L, Dvorkin M, Chen Y et al (2019) Durvalumab plus platinum–etoposide versus platinum– etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 394(10212):1929–1939
  • National Comprehensive Cancer Network. Neuroendocrine and Adrenal Tumors (Version 1.2019). https://www.nccn. org/professionals/physician_gls/pdf/neuroendocrine.pdf (Ac- cess date: 05/03/2020).
  • Sahin, A. B., Cubukcu, E., Birol, O. et al (2020). Chemo-immunotherapy with atezolizumab in extensive-stage small-cell lung cancer; Single-Center Experience. International Journal of Hematology and Oncology, 33(1), 148-154.
  • Gürbüz M, Kutlu Y, Akkuş E, et al (2022). Atezolizumab combined with chemotherapy in the first-line treatment of extensive-stage small cell lung cancer: a real-life data of the Turkish Oncology Group. J Cancer Res Clin Oncol. 2022 Dec;148(12):3547-3555.
  • Yang F, Markovic SN, Molina JR, et al (2020) Association of sex, age, and Eastern Cooperative Oncology Group performance status with survival benefit of cancer immunotherapy in randomized clinical trials: a systematic review and meta-analysis. JAMA Netw Open 3(8):e2012534
  • Rudin CM, Awad MM, Navarro A, et al (2020) Pembrolizumab or placebo plus etoposide and platinum as first-line therapy for extensive-stage small-cell lung cancer: randomized, double-blind, phase III KEYNOTE-604 study. J Clin Oncol 38(21):2369
  • Reck, M., Liu, S. V., Mansfield, A. S., et al (2019). IMpower133: Updated overall survival (OS) analysis of first-line (1L) atezolizumab (atezo)+ carboplatin+ etoposide in extensive-stage SCLC (ES-SCLC). Annals of Oncology, 30, v710-v711.
  • Paz-Ares, L., Goldman, J. W., Garassino, M. C., et al(2019). PD-L1 expression, patterns of progression and patient-reported outcomes (PROs) with durvalumab plus platinum-etoposide in ES-SCLC: results from CASPIAN. Annals of Oncology, 30, v928-v929.
  • Nesbit EG, Leal TA, Kruser TJ. What is the role of radiotherapy for extensive-stage small cell lung cancer in the immuno- therapy era? Transl Lung Cancer Res 8: 153-162, 2019.
Toplam 17 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Onkoloji
Bölüm Araştırma Makalesi
Yazarlar

Bilgin Demir

Ömer Faruk Akgül

Ali Aytaç

Ayhan Açlan

Onur Yazdan Balçık

Mehmet Uzun

Esin Oktay

Yayımlanma Tarihi 30 Eylül 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

APA Demir, B., Akgül, Ö. F., Aytaç, A., Açlan, A., vd. (2023). Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?. Turkish Journal of Clinics and Laboratory, 14(3), 476-481. https://doi.org/10.18663/tjcl.1338507
AMA Demir B, Akgül ÖF, Aytaç A, Açlan A, Balçık OY, Uzun M, Oktay E. Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?. TJCL. Eylül 2023;14(3):476-481. doi:10.18663/tjcl.1338507
Chicago Demir, Bilgin, Ömer Faruk Akgül, Ali Aytaç, Ayhan Açlan, Onur Yazdan Balçık, Mehmet Uzun, ve Esin Oktay. “Küçük hücreli akciğer Kanserinde Daha Fazla Kombine Kemoterapi Ile Atezolizumab kullanımı sağkalımı uzatır mı?”. Turkish Journal of Clinics and Laboratory 14, sy. 3 (Eylül 2023): 476-81. https://doi.org/10.18663/tjcl.1338507.
EndNote Demir B, Akgül ÖF, Aytaç A, Açlan A, Balçık OY, Uzun M, Oktay E (01 Eylül 2023) Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?. Turkish Journal of Clinics and Laboratory 14 3 476–481.
IEEE B. Demir, Ö. F. Akgül, A. Aytaç, A. Açlan, O. Y. Balçık, M. Uzun, ve E. Oktay, “Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?”, TJCL, c. 14, sy. 3, ss. 476–481, 2023, doi: 10.18663/tjcl.1338507.
ISNAD Demir, Bilgin vd. “Küçük hücreli akciğer Kanserinde Daha Fazla Kombine Kemoterapi Ile Atezolizumab kullanımı sağkalımı uzatır mı?”. Turkish Journal of Clinics and Laboratory 14/3 (Eylül 2023), 476-481. https://doi.org/10.18663/tjcl.1338507.
JAMA Demir B, Akgül ÖF, Aytaç A, Açlan A, Balçık OY, Uzun M, Oktay E. Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?. TJCL. 2023;14:476–481.
MLA Demir, Bilgin vd. “Küçük hücreli akciğer Kanserinde Daha Fazla Kombine Kemoterapi Ile Atezolizumab kullanımı sağkalımı uzatır mı?”. Turkish Journal of Clinics and Laboratory, c. 14, sy. 3, 2023, ss. 476-81, doi:10.18663/tjcl.1338507.
Vancouver Demir B, Akgül ÖF, Aytaç A, Açlan A, Balçık OY, Uzun M, Oktay E. Küçük hücreli akciğer kanserinde daha fazla kombine kemoterapi ile atezolizumab kullanımı sağkalımı uzatır mı?. TJCL. 2023;14(3):476-81.


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