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Real-World Treatment Patterns and Clinical Outcomes in Patients With Extensive-Stage Small Cell Lung Cancer Treated With First-Line Platinum-Based Chemotherapy and ≥ 2 Subsequent Lines of Therapy in the United States

Year: 2025

Type: article

Abstract: Although patients with extensive-stage small cell lung cancer (ES-SCLC) typically respond well to first-line (1L) platinum-based chemotherapy (PBC)-containing regimens, disease recurrence is common, and survival is short. Treatment options beyond 1L are limited, leaving an urgent need for more effective treatment options. Understanding patient characteristics, treatment patterns, and clinical outcomes in this setting may inform clinical development of novel therapies for ES-SCLC. This study is a retrospective, observational analysis of real-world data from a US nationwide electronic health record-derived de-identified database. Patients with ES-SCLC who received 1L PBC between January 1, 2018, and June 30, 2023, were included. Treatment patterns were analyzed in all patients, and clinical outcomes from third-line (3L) therapy initiation were assessed in those who also received 3L treatment. The study period (January 1, 2018, through December 31, 2023) allowed for ≥ 6 months’ potential follow-up. Of 2573 patients (50.5% female; 49.5% male) included in the overall population, 992 (38.6%), 344 (13.4%), and 114 (4.4%) received ≥ 1, ≥ 2, and ≥ 3 subsequent treatment lines, respectively. Treatment patterns beyond 1L were fragmented: the most common second-line treatments were lurbinectedin-containing regimens (26.5%), and in 3L were lurbinectedin-containing regimens (21.8%) or topoisomerase inhibitors (21.8%). From 3L therapy initiation, median real-world overall survival (rwOS) was 4.53 months (95% confidence interval [CI] 3.71–5.39), median real-world time to treatment discontinuation or death (rwTTD/D) was 2.56 months (95% CI, 2.27–2.79), median real-world time to next treatment or death (rwTTNT/D) was 2.92 months (95% CI, 2.69–3.12), and real-world response rate among 77 evaluable patients was 11.7% (95% CI, 5.5–21.0). This study demonstrated the heterogeneity of treatments after 1L PBC-containing therapy for patients with ES-SCLC, with no clear standard of care identified. In 3L, rwTTD/D, rwTTNT/D, and rwOS were short, demonstrating the substantial unmet need for novel treatments in this setting. Most patients diagnosed with extensive-stage small cell lung cancer (ES-SCLC) receive platinum-based chemotherapy with or without an immune checkpoint inhibitor as first-line treatment. For ES-SCLC, platinum-based chemotherapy normally consists of carboplatin or cisplatin given alongside etoposide. While most patients initially respond well to first-line platinum-based chemotherapy, disease relapse is common; these patients then require additional treatments. Understanding treatment patterns among patients with relapsed disease (i.e., how they are currently treated), as well as how long they remain on those treatments and how long they survive after starting them, may help inform the development of new drugs. This study aimed to answer these questions by looking at information from electronic health records of patients in the United States, allowing an understanding of treatment patterns and clinical outcomes in patients who are treated in everyday practice, rather than in clinical trials. This study showed that among patients receiving their second treatment after platinum-based chemotherapy (third-line therapy), a range of different therapies was used, with no single type of treatment used a lot more than any other. On average, patients receiving third-line therapy remained on treatment for less than 3 months and survived for approximately 4.5 months. These results show that patients with ES-SCLC who initially receive platinum-based chemotherapy and then experience relapsed disease have an urgent need for better treatments.

Source: Advances in Therapy

DOI: 10.1007/s12325-025-03408-z