Abstract 1543P
Background
SCLC is an aggressive neuroendocrine malignancy with poor prognosis. Development of new effective treatments was limited until the emergence of immune checkpoint inhibitors. The anti-PD-L1 therapies, atezolizumab and durvalumab, received EU approval for 1st-line (1L) treatment of extensive stage SCLC (ES-SCLC) in 2019 and 2020, respectively. To better characterise the emerging treatment landscape, we investigated SCLC treatment patterns in France, Germany, Spain, Italy and the UK.
Methods
The study included all adults aged ≥18 years who were diagnosed with ES-SCLC and received any systemic treatments between Q1 2018 and Q4 2021 from a representative, retrospective oncology database. Baseline characteristics and treatment regimens by year, line of therapy, and platinum-sensitivity status were described.
Results
Of 5832 eligible patients (1L=4898, 2L=804, 3L+=130), 3843 were male (65.9%), with a median age of 66 years. Most patients were diagnosed with stage IV disease (88.4%). The most common 1L regimens over 2018–2021 were platinum + etoposide combination chemotherapies (91.8%, 86.0%, 62.9%, 42.3%, respectively; Table). Use of a platinum-based regimen + atezolizumab increased from 2019 to 2021 (5.6%, 27.3%, 40.0%, respectively). In 2021, platinum + atezolizumab was the most common 1L regimen in Germany (54.8%), France (46.2%) and the UK (43.7%). In France, platinum + durvalumab was the second most common therapy in 2021, accounting for 30.3% of 1L regimens, but this combination was uncommon in Germany (2.7%), Spain (2.0%), the UK (0.4%) and Italy (0.3%). Uptake of immune checkpoint inhibitor use was also observed in 2L treatment between 2019–2021 (3.8%, 4.9%, 11.0%, respectively), equally distributed for both platinum-resistant and platinum-sensitive patients. Table: 1543P
Regimens by year in 1L ES-SCLC in Europe
| Regimen | 2018 (n=1176) | 2019 (n=1190) | 2020 (n=1329) | 2021 (n=1203) |
| Platinum1 + etoposide | 1079 (91.7) | 1023 (86.0) | 835 (62.8) | 509 (42.3) |
| Platinum mono | 30 (2.6) | 49 (4.1) | 43 (3.2) | 49 (4.1) |
| Platinum1 + atezolizumab | 0 | 67 (5.6) | 363 (27.3) | 481 (40.0) |
| Platinum1 + durvalumab | 0 | 0 | 6 (0.5) | 53 (4.4) |
| Anti-PD-(L)1/anti-CTLA-4 mono or combo2 | 2 (0.2) | 8 (0.7) | 32 (2.4) | 63 (5.2) |
| Etoposide mono | 18 (1.5) | 11 (0.9) | 9 (0.7) | 8 (0.7) |
| Other3 | 47 (4.0) | 32 (2.7) | 41 (3.1) | 40 (3.3) |
Data are n (%). 1Platinum-based chemo. 2Includes atezolizumab, durvalumab, nivolumab, pembrolizumab, tremelimumab, ipilimumab. 3Includes platinum combos, non-platinum-based chemo, and other non-chemo treatments
Conclusions
Since approval, use of anti-PD-L1 inhibitor combination therapy as a 1L treatment of ES-SCLC in Europe increased, although the speed of uptake varied between countries.
Clinical trial identification
Editorial acknowledgement
Editorial assistance was provided by David Cutler, PhD at Aspire Scientific Limited (Bollington, UK).
Legal entity responsible for the study
Amgen Ltd.
Funding
Amgen Ltd.
Disclosure
N. Reguart Aransay: Financial Interests, Personal, Advisory Board: Roche, MSD, Takeda, Bayer, Novartis, Sanofi, Janssen, Astra-Zeneca; Financial Interests, Personal, Invited Speaker: Astra-Zeneca, MSD, Boehringer, Guardant, BMS, Pfizer. S. Puntis: Financial Interests, Personal, Full or part-time Employment: Amgen. K. Ohrling: Financial Interests, Personal, Full or part-time Employment: Amgen; Financial Interests, Personal, Stocks/Shares: Amgen. A. Abbasi: Financial Interests, Personal, Other, Contract work: Amgen. K.S. Louie: Financial Interests, Personal, Full or part-time Employment: BioMarin Pharmaceutical Inc; Financial Interests, Personal, Stocks/Shares: BioMarin Pharmaceutical Inc, Amgen. M. Sebastian: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Novartis, Takeda, Lilly, BMS, MSD, Merck, Johnson, Amgen; Financial Interests, Personal, Invited Speaker: Roche, GSK; Financial Interests, Institutional, Research Grant: AstraZeneca.