ArticleJournal of thoracic disease2025
First-line serplulimab-based immunochemotherapy in elderly patients with extensive-stage small cell lung cancer: a multicenter, real-world study.
Article in Journal of thoracic disease, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While immune checkpoint inhibitors (ICIs) in combination with chemotherapy have improved outcomes for patients with extensive-stage small cell lung cancer (ES-SCLC), elderly patients (≥70 years) are often underrepresented in clinical trials, and real-world evidence on their efficacy and safety remains scarce. We conducted a real-world study to supplement data on using serplulimab [a programmed cell death protein 1 (PD-1) inhibitor] with chemotherapy as first-line treatment for elderly (≥70 years) ES-SCLC patients. Methods: We gathered data on ES-SCLC patients aged 70 and above treated with first-line serplulimab, focusing on progression-free survival (PFS) as the primary endpoint. Secondary endpoints included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Kaplan-Meier survival curves were used for PFS and OS, and Cox proportional hazards models and accelerated failure time (AFT) models were used for the subgroup analyses. The baseline and post-4-cycle neutrophil-to-lymphocyte ratio (NLR) levels were also collected as exploratory endpoints. Results: Forty-three ES-SCLC patients with a median age of 73 years were included. Median PFS was 7.0 months [95% confidence interval (CI): 6.1-12.5]. Subgroup analysis indicated a significantly higher risk of disease progression in female patients (P=0.04) and those who had brain radiotherapy (P<0.001). OS rate was 94.7% (95% CI: 87.9-100.0%) at 6 months and 65.8% (95% CI: 50.0-86.5%) at 1 year. The ORR was 65.12% (95% CI: 49.07-78.99%), and the DCR was 97.67% (95% CI: 87.71-99.94%). AEs occurred in 19 patients (44.19%), mostly grade 1-2 (14 patients, 32.56%), with grade ≥3 AEs in 11.63% (5 patients). There was no significant difference in NLR levels before and after patient treatment. Conclusions: This study showed that combining serplulimab with chemotherapy improved survival and reduced toxicity in elderly ES-SCLC patients. Additionally, NLR may not be suitable as a biomarker for the elderly ES-SCLC population.
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