Cancer Res Treat.  2024 Apr;56(2):430-441. 10.4143/crt.2023.931.

Intrathoracic Progression Is Still the Most Dominant Failure Pattern after First-Line Chemo-immunotherapy in Extensive-Stage Small-Cell Lung Cancer: Implications for Thoracic Radiotherapy

• Kim D
• Kim HJ
• Wu HG
• Lee JH
• Kim S
• Kim TM
• Kim JS
• Kim BH

• KMID: 2554334
• DOI: http://doi.org/10.4143/crt.2023.931

Abstract

Purpose
This study aimed to compare the failure patterns before and after the introduction of immunotherapy and to determine the role of thoracic radiotherapy (TRT) in extensive-stage small-cell lung cancer (ES-SCLC) treatment.
Materials and Methods
We retrospectively reviewed 294 patients with ES-SCLC, of which 62.2% underwent chemotherapy alone, 13.3% underwent chemotherapy followed by consolidative TRT (TRT group), and 24.5% underwent chemotherapy with immune checkpoint inhibitor (ICI group). We performed propensity-score matching (PSM) to compare each treatment group.
Results
The median follow-up duration was 10.4 months. At the first relapse, in the cohort showing objective response, the proportion of cases showing intrathoracic progression was significantly lower in the TRT group (37.8%) than in the chemotherapy-alone (77.2%, p < 0.001) and the ICI (60.3%, p=0.03) groups. Furthermore, in the subgroup analysis, TRT showed benefits related to intrathoracic progression-free survival (PFS) in comparison with ICI in patients with less than two involved extrathoracic sites (p=0.008) or without liver metastasis (p=0.02) or pleural metastasis (p=0.005) at diagnosis. After PSM, the TRT group showed significantly better intrathoracic PFS than both chemotherapy-alone and ICI groups (p < 0.001 and p=0.04, respectively), but showed no significant benefit in terms of PFS and overall survival in comparison with the ICI group (p=0.17 and p=0.31, respectively).
Conclusion
In ES-SCLC, intrathoracic progression was the most dominant failure pattern after immunotherapy. In the era of chemoimmunotherapy, consolidative TRT can still be considered a useful treatment strategy for locoregional control.

Keyword

Extensive-stage small-cell lung cancer; Thoracic radiotherapy; Patterns of progression

Figure

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  Fig. 1. Kaplan-Meier curves of intrathoracic progression-free survival (A) and progression-free survival (B) according to the treatment group in the entire cohort. CTx, chemotherapy; ICI, immune checkpoint inhibitor; TRT, thoracic radiotherapy.

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  Fig. 2. Kaplan-Meier curves of intrathoracic progression-free survival and progression-free survival in the propensity-score matched cohorts. The chemotherapy-alone and the TRT groups were matched in a 2:1 ratio, and intrathoracic progression-free survival (A) and progression-free survival (B) were compared. The chemotherapy-alone and the ICI groups were matched in a 2:1 ratio, and intrathoracic progression-free survival (C) and progression-free survival (D) were compared. The TRT and the ICI groups were matched in a 1:1 ratio, and intrathoracic progression-free survival (E) and progression-free survival (F) were compared. CTx, chemotherapy; ICI, immune checkpoint inhibitor; TRT, thoracic radiotherapy.

• 

  Fig. 3. Intrathoracic progression-free survival (A) and progression-free survival (B) according to subgroup analyses between the TRT and ICI groups in the cohort with an objective response. CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; HR, hazard ratio; ICI, immune checkpoint inhibitor; TRT, thoracic radiotherapy.

Reference

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