Characteristics and clinical outcomes of a nationwide cohort of patients with small cell lung cancer following first-line treatment: Real-world evidence

Abstract

Background: Patients with small cell lung cancer (SCLC) have an unfavorable prognosis. Our aim was to describe characteristics and clinical outcomes of a nationwide cohort of patients. Methods: Multicenter, observational, ambispective study based on the Spanish Thoracic Tumor Registry. From August 2016 to June 2023, patients aged ≥ 18 with SCLC undergoing oncological treatment following first-line therapy were eligible. Descriptive statistical analyses, cox proportional hazards model, and Kaplan-Meier survival curves were performed. Results: 1,284 patients were included. 941 (73.3%) were men. The median age was 63.2 years. 68.1% had extensive-stage disease (ES-SCLC) at diagnosis, 87.9% had Eastern Cooperative Oncology Group (ECOG) 0–1, 90.8% received first-line platinum-based chemotherapy. The median chemotherapy-free interval (CTFI) was 230.5 days for patients with limited-stage disease (LS-SCLC) at diagnosis and 100 days for those with ES-SCLC. After a median follow-up of 72.6 months, the median progression-free survival (PFS) was 5.8 months for patients with LS-SCLC versus 4.6 months for those with ES-SCLC, HR 1.22p 0.010. The median overall survival (OS) was 16.5 months in patients with CTFI ≥ 90 versus 10.2 months in those with CTFI < 90 (p < 0.001). Factors associated with OS were ES-SCLC (HR: 1.57, p < 0.01), ECOG ⩾2 (HR: 1.43, p 0.03), CTFI ⩾90 (HR: 0.34, p < 0.001), and CTFI ⩾180 (HR: 0.20, p < 0.01). Conclusions: Clinical outcomes are poor in our patients, with slightly better results for those with chemotherapy-sensitive disease. Factors influencing prognosis include tumor extent, performance status, and CTFI. New treatment options are required to improve survival in this oncological population.