Small cell lung cancer (SCLC) is an aggressive malignancy with a relatively poor prognosis. Until recent gains with immunotherapy, treatment options and survival had not advanced for decades. We aimed to evaluate our local treatment patterns, prognostic factors and compare real-world survival data to published literature.
A retrospective observational analysis of SCLC patients diagnosed within our health district was conducted (01/2017 to 05/2020). Co-morbidity was quantified by Charlson comorbidity index (CCI). Progression-free survival (PFS) and overall survival (OS) were defined from date of diagnosis to progression, or death, respectively. The Kaplan Meier method and logrank tests were used for analysis.
Of 77 patients, 51% were female, median age was 68 years (range 52-91) and 71% had extensive-stage (ES) disease. At baseline, 61% had performance status (PS) 0-1. The predominant platinum used in limited stage (LS) vs ES, was Cisplatin (60%) vs Carboplatin (80%), respectively. Median follow-up was 8.9 months (mo). For LS-SCLC vs ES-SCLC: median PFS was 8.7 vs 6.6 mo; whilst median OS was not reached vs 8.1 mo. In ES-SCLC, second and third-line therapy was received by 27% and 15% of patients, respectively (usually camptothecin or platinum-based regimens). For ES-SCLC, there were differences in OS between: PS 0-1 vs ≥2 (median 11.5 vs 2.2mo, HR 8.0, p=0.005); age <70 vs ≥70 (10.1 vs 5.5 mo, HR 3.9, p=0.047); and CCI <8 vs ≥8 (11.3 vs 5.1 mo, HR 4.6, p=0.033). Those who received treatment had a median OS of 10.1 mo, compared to 1.9 mo without any treatment.
Our unselected real-world population survival outcomes were comparable to historical literature (atezolizumab only PBS-funded from March 2020). We confirmed that in ES-SCLC, poorer PS, increasing age and heavier co-morbidity burden significantly impacted survival. Future work will evaluate the real-world impact of immunotherapy and other novel agents.