A new era of immunotherapy: Comparison of real-world outcomes in limited-stage small cell lung cancer.

Abstract

e20141 Background: Concurrent chemoradiation (CCRT) followed by consolidative anti-PD-L1 immunotherapy (IO) with durvalumab (ADRIATIC) significantly improved both progression-free survival (PFS) and overall survival (OS) in limited-stage SCLC (LS-SCLC), leading to regulatory approval as the new standard of care. Real-world outcomes of patients receiving durvalumab following CCRT for LS-SCLC have not yet been reported. Methods: We retrospectively reviewed the charts of patients diagnosed with LS-SCLC who received CCRT from January 1 to December 31, 2024 in the Indiana University (IU) Health System. Platinum selection (cisplatin or carboplatin), radiation schedule (XRT, once-daily for 60-66 Gy or twice-daily for 45 Gy) and receipt of prophylactic cranial irradiation (PCI) was collected. Patients were stratified by receipt of durvalumab consolidation after CCRT. Fisher’s exact and Wilcoxon rank sum tests were applied to categorical and continuous variables, respectively. Univariate Cox analysis for PFS by IO status was performed. Results: Among the 416 individuals with SCLC, 25 patients had LS-SCLC treated with CCRT (Table 1), including 14 patients (56%) who received consolidative IO. The groups (no IO vs IO) were well balanced, with no significant difference observed in age at diagnosis, sex, ECOG performance status (PS), pre-existing diagnoses of COPD or autoimmune disease, or tobacco use between groups. There was no difference in receipt of PCI between cohorts. With the addition of IO consolidation, a significant improvement in median PFS (≥9.7 vs 6.1 months, P = 0.007) was observed; median OS was numerically higher but did not reach statistical significance (18.2 vs 15.2 months, P = 0.07) with <24 months of median follow-up. Conclusions: In our cohort, the addition of consolidative durvalumab significantly improved PFS and trended towards higher OS in real-world setting for patients with LS-SCLC who received CCRT, while we await data maturation. Carboplatin and once-daily XRT for 60-66 Gy were commonly used in our real-world cohort, while PCI was administered in a minority of patients studied. Characteristic No IO (n = 11) +IO (n = 14) Overall (n = 25) P value Age (Q1, Q3) 67 (64, 74) 69 (64, 78) 69 (64, 75) 0.6 Sex (female) 5 (45%) 10 (71%) 15 (60%) 0.2 ECOG PS (0-1) 7 (64%) 12 (86%) 19 (76%) 0.13 Current tobacco use 7 (64%) 11 (79%) 18 (72%) 0.7 Former tobacco use 4 (36%) 3 (21%) 7 (28%) 0.7 Autoimmune history 1 (9.1%) 2 (14%) 3 (12%) >0.9 +PCI 3 (27%) 3 (21%) 6 (24%) >0.9 Platinum agent (carboplatin) 6 (55%) 8 (57%) 14 (56%) >0.9 XRT schedule (once-daily, 60-66 Gy) 8 (73%) 11 (79%) 19 (76%) 0.4