Abstract 202P
Background
In extensive-stage small cell lung cancer (ES-SCLC), chemoimmunotherapy (CIO) has become the first-line (1L) standard of care. Limited data on response and survival outcomes after CIO in subsequent treatment lines are available. We assessed second-line (2L) outcomes for patients (pts) with ES-SCLC following progression after initial CIO.
Methods
We retrospectively extracted multi-centre patient data from the Australian Registry and Biobank of Thoracic Cancers (AURORA). Population characteristics and treatment outcomes were summarized with descriptive statistics. Survival was estimated using the Kaplan-Meier method, with Cox proportional hazards model for estimating the effects of covariates.
Results
We included 111 pts from 10 Australian centers. Median age was 65 years; 58% male, 96% current or past smokers, and 74% were ECOG PS ≤1 at initial presentation. At diagnosis, 51% of the patients had liver, and 14% had brain metastasis. A median number of 8 cycles (Q1-Q3 5-9.8) of IO (97% Atezolizumab) were administered before starting 2L treatment, including induction therapy. The most frequent 2L regimens were Lurbinectedin (32%), re-challenge with Carboplatin/Etoposide (21%), CAV (Cyclophosphamide/ Doxorubicin/ Vincristine) (20%), and Topotecan (9%). In the re-challenge cohort, the median time from 1L platinum to 2L platinum was 192 days (Q1-Q3 156-308; 65% ≥ 180 days). Across all treatment groups, the 2L objective response rate was 22%. Median 2L duration of response was 2.2 months (CI 95% 1.7-3.3) and median 2L progression-free survival was 2.9 months (CI 95% 2.5-3.7). Median 2L overall survival was 5.8 months (CI 95% 4.6-6.4), with a 6-month and 12-month survival of 49% and 14%, respectively. Twenty-six pts (23%) subsequently went on to receive third-line therapy, 8 pts (7%) proceeded to fourth-line, and 2 pts (2%) advanced to a fifth-line treatment setting.
Conclusions
Following CIO in the first-line context, 2L survival outcomes resemble those of previously published chemotherapy-alone first-line patients. In this multicentre cohort, 2L-treatment response and survival remain poor in ES-SCLC, suggesting a limited residual impact of immunotherapy.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
M. Alexander: Financial Interests, Personal, Advisory Board: BMS, Pfizer; Financial Interests, Personal, Other, mentor program: AstraZeneca. S. Parakh: Financial Interests, Personal, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker, Speaking Honoraria:MSD, Roche, AstraZeneca; Financial Interests, Personal, Sponsor/Funding, Research funding: Bayer, Roche. S.E. Bowyer: Financial Interests, Personal, Advisory Board, Cabozantinib ad board: Ipsen; Financial Interests, Personal, Advisory Board, Selpercatinib ad board: Lilly; Financial Interests, Personal, Advisory Board, Cemiplimab ad board: Sanofi; Financial Interests, Personal, Advisory Board, pembrolizumab in H&N cancer Rx:MSD; Financial Interests, Personal, Advisory Board, Neoadjuvant Rx of lung cancer: Roche; Financial Interests, Personal, Invited Speaker, neoadjuvant lung cancer Rx: BMS; Financial Interests, Personal, Invited Speaker, Immunotherapy in lung cancer:MSD; Financial Interests, Personal, Invited Speaker, Cemiplimab in Rx of advanced cutaneous SCC: Sanofi; Financial Interests, Personal, Advisory Board, Amivantimab in lung cancer: Janssen; Non-Financial Interests, Personal, Principal Investigator: BMS, GSK, Genentech, Roche, Enliven Therapeutics Inc, FLX Bio, Lilly, Hummingbird Bioscience, WMBIO, Regeneron, Janssen, ALX Oncology, Replimmune. T.D. Clay: Financial Interests, Personal, Other, Honoraria: Lilly, Roche, MSD, The Limbic; Financial Interests, Personal, Advisory Role: AstraZeneca, MedImmune, Takeda, Merck KGaA, Merck/Pfizer, Ipsen, AstraZeneca/Daiichi Sankyo, Janssen, Roche; Financial Interests, Personal, Speaker’s Bureau: AstraZeneca, MedImmune; Financial Interests, Institutional, Funding, Research funding: Exelixis, Immutep, Clovis Oncology, MSD Oncology, Pfizer, Amgen, Daiichi Sankyo, AstraZeneca, AbbVie, Janssen Oncology, BeiGene, Bayer, BridgeBio Pharma, BMS GmbH & Co.KG; Financial Interests, Personal, Funding, travel expenses: AstraZeneca, Daiichi Sankyo/UCB Japan, Boehringer Ingelheim. S. Arulananda: Financial Interests, Personal, Invited Speaker: Merck-Sharpe & Dohme, AstraZeneca, BMS, Merck Serono, Takeda; Financial Interests, Personal, Funding, travel support: AstraZeneca, Roche, Merck-Sharpe & Dohme; Financial Interests, Personal, Advisory Board: Roche, BeiGene; Financial Interests, Personal, Sponsor/Funding, Research funding: AstraZeneca, Pfizer. S.C. Kao: Financial Interests, Personal, Other, Honorarium: MSD, BMS, Roche, AZ, Pfizer, Takeda and BeiGene; Financial Interests, Personal, Advisory Board: AZ, Pfizer, MSD, BMS, Roche, Amgen, Beigen and Boehringer; Financial Interests, Personal, Research Grant: AZ. I. Pires Da Silva: Financial Interests, Personal, Invited Speaker: Roche, BMS, MSD, Novartis, Pierre Fabre; Financial Interests, Personal, Other, travel support: BMS, MSD; Financial Interests, Personal, Advisory Board: MSD. Pires Da Silva: Financial Interests, Personal, Invited Speaker: Roche, BMS, MSD, Novartis, Pierre Fabre; Financial Interests, Personal, Other, travel support: BMS, MSD; Financial Interests, Personal, Advisory Board: MSD. M. Itchins: Financial Interests, Personal, Advisory Board: Pfizer, Takeda, Bayer, MSD, Amgen, Merck, Roche, BeiGene, Janssen; Financial Interests, Personal, Other, Consultancy: Roche, Merck; Financial Interests, Personal, Research Grant: Pfizer; Financial Interests, Personal, Other, Honoraria: Pfizer, AstraZeneca, Takeda, Roche, Novartis, BMS,MSD, Bayer, Janssen. Itchins: Financial Interests, Personal, Advisory Board: Pfizer, Takeda, Bayer, MSD, Amgen, Merck, Roche, BeiGene, Janssen; Financial Interests, Personal, Other, Consultancy: Roche, Merck; Financial Interests, Personal, Research Grant: Pfizer; Financial Interests, Personal, Other, Honoraria: Pfizer, AstraZeneca, Takeda, Roche, Novartis, BMS, MSD, Bayer, Janssen. B. Solomon: Financial Interests, Institutional, Advisory Board: AstraZeneca, Novartis, Merck, Bristol Myers Squibb; Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Roche/Genentech; Financial Interests, Personal, Advisory Board: Amgen, Roche-Genentech, Eli Lilly, Takeda, Janssen; Financial Interests, Personal, Full or part-time Employment, Employed as a consultant Medical Oncologist at Peter MacCallum Cancer Centre: Peter MacCallum Cancer Centre; Financial Interests, Personal, Member of Board of Directors: Cancer Council of Victoria, Thoracic Oncology Group of Australasia; Financial Interests, Personal, Royalties: UpToDate; Financial Interests, Institutional, Invited Speaker, Principal Investigator and Steering committee Chair: Roche/Genentech, Pfizer; Financial Interests, Institutional, Invited Speaker: Novartis. T. John: Financial Interests, Personal, Invited Speaker, Speaker tour Vietnam: AstraZeneca; Financial Interests, Personal, Invited Speaker, CTIO: Merck Sharp Dohme; Financial Interests, Personal, Advisory Board: BMS, AstraZeneca, Bayer, Specialised Therapeutics; Financial Interests, Institutional, Advisory Board: Roche, Novartis, Pfizer, Amgen, Takeda, PharmaMar; Financial Interests, Personal, Other, Speaker/Chair: ACE Oncology. All other authors have declared no conflicts of interest.