PD-L1 Inhibitor Plus Chemotherapy Shows Safety, Efficacy in Older Adults With ES-SCLC

Combining a PD-L1 inhibitor with chemotherapy as a first-line treatment for extensive-stage small cell lung cancer (ES-SCLC) is effective in older adults and does not involve “any additional serious adverse events [AEs],” compared with younger patients, according to a recent study.

Masashi Sonoda, MD, of the National Cancer Center Hospital, and colleagues conducted the study and presented their findings during the American Thoracic Society 2024 International Conference.

The researchers aimed to address the “limited data” on the efficacy and safety of combining a PD-L1 inhibitor with chemotherapy in older adults with ES-SCLC, as the treatment is the standard of care for first-line treatment of ES-SCLC. Dr. Sonoda and colleagues conducted a retrospective study that evaluated patients aged 75 years and older who received carboplatin and etoposide plus a PD-L1 inhibitor (atezolizumab or durvalumab) as a first-line treatment for ES-SCLC at 1 institution from February 2020 to June 2023 (n=27). The researchers also evaluated patients who received chemotherapy alone from November 2016 to January 2020 (n=22).

Dr. Sonoda and colleagues analyzed patient characteristics, AEs, and survival. They compared the incidence of immune-related AEs (irAEs) in patients receiving immunotherapy plus chemotherapy with the data on patients who were under 75 during the same period.

The objective response rate (ORR) of patients who received a PD-L1 inhibitor plus chemotherapy was 63%, and the ORR was 50% in those who received chemotherapy alone. The median progression-free survival (PFS) was 7.53 months (95% CI, 4.40-9.14) in patients receiving a PD-L1 inhibitor plus chemotherapy, compared with a median PFS of 5.43 months (95% CI, 4.20-6.73; P=.080) in those receiving chemotherapy alone. The median overall survival (OS) was 17.50 months in patients receiving a PD-L1 inhibitor plus chemotherapy (95% CI, 13.30 to not reached), compared with 9.87 months (95% CI, 5.70-17.70; P=.055) in those receiving chemotherapy alone.

The researchers also investigated the safety of the treatments, finding that there were “no significant differences in the frequency of [AEs]” between the 2 groups. In addition, the incidence of irAEs in older patients receiving a PD-L1 inhibitor plus chemotherapy was 14.8%, which was “similar to younger patients,” who had an irAE incidence of 17.4%.

“The combination of a PD-L1 inhibitor with chemotherapy as the first-line treatment of ES-SCLC is also effective in elderly patients as it is in younger patients, without any additional serious [AEs],” Dr. Sonoda and colleagues concluded.

Reference

Sonoda M, Shinno Y, Yamaguchi Y. Efficacy and safety of first-line immunotherapy plus chemotherapy in treating elderly patients with extensive-stage small cell lung cancer. Poster #421. Presented at the American Thoracic Society 2024 International Conference; May 17-22, 2024; San Diego, California.