Findings from a meta-analysis published in the journal Thoracic Cancer revealed that adding immunotherapy to chemotherapy in patients with SCLC is correlated with a greater risk of toxicity and possibly termination of therapy.
The researchers conducted a systematic review and meta-analysis to compare any grade TRAEs, grades 3 through 5 TRAEs, grade 5 TRAEs, and treatment discontinuation due to TRAEs between extensive-stage SCLC (ES-SCLC) patients receiving front-line immune checkpoint inhibitors (ICIs) plus chemotherapy and those receiving chemotherapy alone in phase II and III clinical trials.
Outcomes of interest included TRAEs and the rate of termination due to TRAEs.
The meta-analysis was comprised of six phase III randomized, controlled trials (RCTs) and one phase II RCT that included 3,766 patients with SCLC; this included 2,133 patients who received immunotherapy plus chemotherapy and 1,633 patients who received chemotherapy alone.
The immunotherapies investigated included serplulimab, adebrelimab, durvalumab, tremelimumab, atezolizumab, pembrolizumab, and ipilimumab. Chemotherapy consisted of a platinum agent in combination with etoposide or paclitaxel.
The results revealed that ES-SCLC patients treated with immune-based combinations showed a greater risk than patients treated with chemotherapy of any grade TRAEs (odds ratio [OR], 1.63; 95% CI: 1.31-2.03, P = .86). Moreover, immune-based combination treatment was associated with a higher risk than chemotherapy alone of grades 3 through 5 TRAEs (OR, 1.16; 95% CI: 1.01-1.35, P = .93).
There were no variations in grade 5 TRAEs between ES-SCLC patients receiving first-line immune-based combinations and those receiving systemic chemotherapy (OR, 1.56; 95% CI: 0.93-2.63; P = .79).
Immunotherapy-based combinations were correlated with a heightened risk of TRAEs leading to termination as well (OR, 2.30; 95% CI, 1.17-4.54); however, the researchers wrote that this finding “should be interpreted with caution” because the studies employed different immunotherapies and the trial populations were diverse.
“This meta-analysis indicates that the addition of immunotherapy to chemotherapy in SCLC patients is associated with a higher risk of toxicity and probably of treatment discontinuation,” the authors concluded.
The authors also noted that tools for recognizing patients with SCLC who would not benefit from immune-based therapy are urgently warranted, mainly since the availability of these tools would be clinically advantageous for patients with SCLC and enhance cost-effectiveness.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
« Click here to return to Lung Cancer Update.