Evaluation of Real-Life Chemoimmunotherapy Combination in Patients with Metastatic Small Cell Lung Carcinoma (SCLC): A Multicentric Case–Control Study

SIMPLE SUMMARY: Chemoimmunotherapy (CT-IO) is the standard first-line treatment of advanced small cell lung cancer (SCLC). However, very limited efficacy data from real-life use of this combination are available. Moreover, patients included in pivotal phase III trials were highly selected. We conducted a retrospective multicentric (six academic centers) case–control study (n = 153), comparing two cohorts of patients who received first-line treatment, one treated with chemotherapy alone (between January 2017 and December 2018) and one with CT-IO (between January 2019 and December 2020), for an advanced SCLC. CT-IO confirmed its superiority compared to chemo alone. Interestingly, we showed that CT-IO was efficient in patients with brain and liver metastases. However, patients ≥70 years old and with a PS ≥2 did not benefit from CT-IO. This real-life study in one of the largest published to our knowledge on first-line CT-IO for advanced SCLC, with a large focus on specific populations (brain mets, elderly, and impaired PS). ABSTRACT: The current first-line standard treatment for advanced small cell lung cancer (SCLC) is a combination of chemotherapy and immunotherapy. However, few efficacy data are available in a real-life settings, including frail patients. The aim of this study is to describe the real-life efficacy of chemoimmunotherapy in an unselected SCLC population. We conducted a retrospective multicenter study, which compared two cohorts of patients with treatment-naive metastatic SCLC treated in six academic centers in the Greater Paris area. Cohort 1 included patients treated with chemotherapy between January 2017 and December 2018, and cohort 2 included patients treated with chemoimmunotherapy between January 2019 and December 2020. A total of 153 consecutive patients were included (cohort 1: n = 96; cohort 2: n = 57). Clinical characteristics were similar between the two cohorts. Overall survival (OS) was statistically higher in cohort 2 (median survival 15.47 months) than in cohort 1 (median survival 9.5 months) (p = 0.0001). OS for patients with a performance status ≥2 and for patients ≥70 years old was not statistically different between the two cohorts. Chemoimmunotherapy efficacy was better compared to chemotherapy alone in case of brain or liver metastases. In conclusion, the combination of chemoimmunotherapy in metastatic SCLC appears to provide a real-life OS benefit. Dedicated clinical trials are needed to test this strategy in patients with impaired performance status or advanced age.