First-line immune checkpoint inhibitors plus chemotherapy in Taiwanese patients with extensive-stage small-cell lung cancer.

Background: Immune checkpoint inhibitors (ICIs) have demonstrated survival benefits when combined with platinum and etoposide (EP) in first-line (1L) treatment for extensive-stage small-cell lung cancer (ES-SCLC). We investigated the real-world outcomes, adverse events (AEs), and prognostic factors of Taiwanese patients with ES-SCLC receiving 1L ICI + EP.

Methods: We analyzed the clinical characteristics, objective response rates, disease control rates (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related AEs of patients with ES-SCLC who received ICI + EP or EP alone as 1L treatment.

Results: A total of 33 patients received ICI + EP, and 199 received EP alone. The 1L ICI + EP group had longer OS than did the 1L EP group (median: 13.9 months vs 8.5 months; p = 0.003). Baseline liver metastasis was associated with shorter 1L PFS, whereas undergoing consolidative thoracic radiotherapy (cTRT) was associated with longer 1L PFS. Baseline liver metastasis, severe hematological AEs (grade ≥ 3), and a neutrophil-to-lymphocyte ratio (NLR) of ≥4 were associated with shorter OS.

Conclusion: Adding ICIs to 1L chemotherapy provides survival benefits in ES-SCLC, while close monitoring for AEs is required. cTRT enhances local tumor control and improves PFS. Liver metastasis is associated with shorter PFS and OS. Severe hematological AEs and an elevated NLR predict poor OS in patients with ES-SCLC undergoing immunochemotherapy.