Real-world treatment patterns and outcomes of chemo-immunotherapy with or without radiotherapy in extensive-stage small cell lung cancer: the durvalumab expanded access cohort

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Purpose: To describe real-world treatment patterns and outcomes among patients with extensive-stage small cell lung cancer (ES-SCLC) treated with first-line chemotherapy plus durvalumab as in CASPIAN trial within Expanded Access Program, with a focus on the use and impact of consolidation (cRT) and salvage radiotherapy (sRT). Patients and methods: This retrospective, multicenter cohort study included patients with ES-SCLC treated with durvalumab plus platinum-etoposide between September 2019 and December 2022 across 11 academic centers in Israel, Poland, Portugal, and Slovenia. Patients characteristics, radiotherapy use, adverse events (AE), and outcomes were collected using a standardized form. Radiotherapy was categorized as cRT, sRT, or palliative RT (pRT). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods and compared using log-rank testing. Multivariable Cox regression evaluated predictors of survival. Results: A total of 133 patients were included (median age 65 years; 74% ECOG PS 0-1). Radiotherapy was administered to 58.6% of patients (cRT 28.2%, sRT 24.3%, pRT 47.4%). Median (m) PFS and mOS for the entire cohort were 6.9 months (m) and 15.9 m, respectively. Patients receiving cRT achieved the longest mPFS (11.7 m) and a mOS of 19.5 m; sRT was associated with an mOS of 20.4 m. Continuation of durvalumab beyond progression combined with RT was associated with improved survival (p = 0.024). Treatment-related AEs occurred in 38.3% of patients, immune-related toxicities were infrequent, and pneumonitis was rare. Conclusion: In this multinational real-world cohort, outcomes with first-line chemo-immunotherapy were consistent with CASPIAN trial. The addition of cRT or sRT appeared feasible, safe, and associated with clinically meaningful survival improvements. Prospective trials are needed to define optimal integration of radiotherapy with chemo-immunotherapy in ES-SCLC.

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