Atezo-Chemo Benefit in Extensive-Stage SCLC Seen Outside Trials, Too

At the virtual European Society for Medical Oncology (ESMO) meeting, researchers explored the clinical characteristics, treatment patterns, and early outcomes of small cell lung cancer (SCLC) patients receiving the IMpower133 regimen — atezolizumab (Tecentriq) added to standard chemotherapy — in the real-world setting.

In this exclusive MedPage Today video, Swapnil Rajurkar, MD, of City of Hope in Duarte, California, offers his perspective on the study.

Following is a transcript of his remarks:

For the treatment of extensive-stage small cell lung cancer, not much had changed since the 1990s until atezolizumab in the combination with carboplatin and etoposide got approved, which was a major change in the treatment of extensive-stage small cell lung cancer patients. This abstract deals with the adoption and early clinical outcomes of atezolizumab plus carboplatin and etoposide in patients with extensive-stage small cell lung cancer in the real-world setting. And I believe that more studies like this should be done, so we can get the real-world perspective of how these patients and these medications perform in real life. And also what are the toxicities of these drugs in real-life patients?

For example, a lot of clinical trials do not include patients with brain metastasis. A lot of clinical trials don’t have marginal- to poor-performance status patients. Whereas in real life, we tend to treat those patients, and that’s why it’s so important to do studies like this.

In this study, close to 500 patients were included. Where these patients were treated with a combination of atezolizumab plus carboplatin and etoposide and their baseline characteristics were similar to the IMpower133 study that got approval for atezolizumab in this setting. In this particular study, these patients had a worse performance status than the patients in the IMpower133 study, more patients had CNS [central nervous system] metastasis at baseline compared to the IMpower133 study. And more patients more than age 65 were included in this study compared to the IMpower133 study. So in a sense, this reflects the real life, extensive-stage small cell lung cancer patients that we see in our clinics every day.

Patients with extensive-stage small cell lung cancer tend to have more comorbidities, and they tend to be long-term smokers. So their performance status is typically worse off than say, a stage IV breast cancer patient at the start of the study. So it is extremely important that we study these combinations like immunotherapy plus chemotherapy — in this case, it happens to be atezolizumab, carboplatin, and etoposide — to see how our patients in real life do when we use these drugs. Are the drugs just as efficacious? How are they tolerated? And fortunately, in this study, the conclusion is that these patients do actually benefit just as much as the patients in the IMpower133 study.