Aim: This study examined real-world treatment patterns for extensive-stage small-cell lung cancer (ES-SCLC) after immune checkpoint inhibitors (ICIs) became available for frontline use. Methods: Adult patients with ES-SCLC initiating 1L systemic treatment were identified from electronic health records. Results: Among patients with recurrent/progressive ES-SCLC, the most common treatment classes were platinum-based chemotherapy (81.1% of 228) and ICI monotherapy (35.1% of 191) in 1L and 2L, respectively. Among patients with de novo ES-SCLC, the most common treatment classes were ICI + platinum-based chemotherapy (64.4% of 1268) and other chemotherapy (44.9% of 512) in 1L and 2L, respectively. Among patients who received no ICI in 1L, 62.6%–70.3% received it in 2L and 62.6–68.5% in 3L. Some who received 1L ICI were re-treated with ICI in subsequent lines (14.5–18.8% in 2L, 18.2–50.0% in 3L). Conclusion: Real-world ICI utilization in ES-SCLC, particularly ICI re-challenge, demonstrates high unmet needs in this patient population.

Plain language summary

Small-cell lung cancer (SCLC) is a type of lung cancer that is highly lethal. About 70% of patients have advanced SCLC when they first get their diagnosis and most die within 5 years. This study focused on immune checkpoint inhibitors (ICIs), a type of treatments that can help the immune system to fight cancer and has only been approved to treat SCLC in the past 4–5 years. We studied 1496 patients with advanced SCLC treated at community cancer practices in USA between October 2018 and February 2020. Patients averaged about 68 years old when they started treatment. By looking at the types and sequences of treatments, we found that although ICI are often used to treat SCLC, patients with this aggressive cancer still need other effective treatment choices.

Tweetable abstract

Real-world utilization patterns of immune checkpoint inhibitors (ICIs) in extensive-stage small cell lung cancer, especially the observation of ICI re-challenge, demonstrate high unmet needs in this patient population.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 15, No. 16

Supplemental Materials

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History

Received 22 March 2023

Accepted 16 August 2023

Published online 11 September 2023

Published in print November 2023

Information

Keywords

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.futuremedicine.com/doi/suppl/10.2217/imt-2023-0073

Author contributions

K Zu: Conceptualization; Investigation; Methodology; Project administration; Supervision; Writing - original draft; Writing – review & editing. A Arunachalam: Conceptualization; Investigation; Methodology; Supervision; Writing – review & editing. A Hohlbauch: Conceptualization; Investigation; Data curation; Formal analysis; Project administration; Writing - original draft; Writing – review & editing. M Silver: Conceptualization; Investigation; Data curation; Formal analysis; Writing – original draft. N Robert: Conceptualization; Investigation; Methodology; Data curation; Writing – review & editing.

Acknowledgments

The authors would like to thank M Catherine Pietanza and R Kester for their insight and help with the inception and design of this study and L Kaspin-Powell for medical writing assistance.

Financial & competing interests disclosure

This work was supported by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. K Zu and A Arunachalam are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA and stockholders of Merck & Co., Inc., Rahway, NJ, USA, the sponsor of this study. N Robert is an employee of Ontada, and Ms. Hohlbauch and Silver were full-time employees of Ontada at the time of study conduct. Ontada received funding from Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA, to conduct this study and prepare the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study protocol was reviewed and approved by the US Oncology Network Institutional Review Board. The study involved the analysis of existing data and records; study information was analyzed by the study team in such a manner that research participants could not be directly identified. Accordingly, exemption status and a waiver of informed consent were granted by the US Oncology Network Institutional Review Board.

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