Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.