Best Treatment of Extensive-Stage Lung Cancer Includes PD-L1 Inhibitor and Etoposide

By Reuters Staff

November 23, 2020

NEW YORK (Reuters Health) - The combination of a programmed-cell-death ligand 1 (PD-L1) inhibitor and etoposide-based chemotherapy appears to be the optimal first-line treatment for patients with extensive-stage small-cell lung cancer (ES-SCLC), according to a new systematic review and network meta-analysis.

Numerous combinations of agents are used in the first-line treatment of ES-SCLC, but the optimal combination regimen remains unclear.

Dr. Li Zhang and colleagues from Sun Yat-sen University Cancer Center, in Guangzhou, China, sought to clarify which first-line combination regimen yields the best tumor response among patients with ES-SCLC in their review of three phase-2 and 11 phase-3 randomized clinical trials involving more than 4,800 patients and eight different regimens.

There was no clearly superior treatment in terms of objective response rate, but the combination of a PD-L1 inhibitor (durvalumab or atezolizumab) plus etoposide-platinum chemotherapy yielded significantly better disease control rate versus chemotherapy alone (hazard ratio, 1.40).

Bevacizumab plus etoposide-based chemotherapy provided the best progression-free survival, but this did not translate into an overall survival benefit.

The most favorable overall survival followed treatment with a PD-L1 inhibitor plus etoposide-based chemotherapy, the researchers report in JAMA Network Open.

The addition of PD-L1 inhibitors to chemotherapy caused no more toxic effects in general than did chemotherapy alone.

Among all first-line treatments for patients with SCLC, the combination of PD-L1 inhibitors plus etoposide-platinum chemotherapy had the highest chance of ranking first for disease control rate and overall survival, whereas the combination of bevacizumab plus etoposide-platinum chemotherapy had the highest chance of ranking first for progression-free survival and treatment-related adverse events of grade 3 or greater.

"These findings could provide recommendations for clinicians in selecting first-line treatments based on their clinical benefits and safety profiles," the authors conclude.

Dr. Zhang did not respond to a request for comments.

SOURCE: JAMA Network Open, online October 19, 2020.