KEY TAKEAWAYS
- The FASTIMMUNE phase II trial aimed to investigate atezolizumab’s role in brain metastasis control in ES-SCLC patients.
- The study evaluated PFS, OS, TTicP and brain PFS.
- Atezolizumab with chemotherapy improves survival and intracranial control in SCLC, supported by first real-world data.
With Impower 133 trial success, atezolizumab addition to etoposide and carboplatin chemotherapy (AECb) is standard for extensive-stage small cell lung cancer (ES-SCLC). Managing CNS progression is crucial for patient survival and quality of life (QoL).
Yoon Namgung and the team spearheaded the study that aimed to investigate the impact of atezolizumab on brain metastasis control in patients with ES-SCLC.
The study included 156 patients diagnosed with ES-SCLC who underwent first-line chemotherapy. Survival outcomes, including progression-free survival (PFS), overall survival (OS), time to intracranial progression (TTicP, with censored deaths), and brain progression-free survival (brain PFS), were assessed.
During the study period, 79 patients (50.6%) underwent chemotherapy without atezolizumab, while 77 patients (49.4%) received AECb as initial treatment. Median follow-up duration was 23.8 months, with no discernible differences between groups in age, sex, or primary metastatic sites. AECb group showed improved CNS outcomes: 27 patients (34.2%) experienced intracranial progression, with 24 cases (30.4%) of new brain metastasis. TTicP (median: 14.6 months vs. not reached; 12-month TTicP rate: 65.4% vs. 84.4%, P = 0.003) and brain PFS (median: 8.2 vs. 11.7 months; 12-month brain PFS rate 30.2% vs. 48.6%, P = 0.001) were significantly prolonged in AECb group. These findings remained consistent after adjusting for age, initial metastatic site, and prophylactic cranial irradiation (PCI). AECb group demonstrated favorable survival outcomes, with improved PFS (median: 4.4 vs. 4.6 months, P = 0.004) and OS (median: 10.2 vs. 12.6 months, P = 0.001).
The results showed that incorporating atezolizumab into standard chemotherapy not only boosts patient survival but also enhances intracranial disease management, prolonging time to intra-cranial progression. These findings provide initial real-world evidence of atezolizumab’s efficacy in controlling intracranial progression in SCLC patients. Research was funded by Fondazione IRCCS Istituto Nazionale dei Tumori, Milano.
Source: https://cslide.ctimeetingtech.com/asia2023/attendee/confcal/show/session/78
Clinical Trial: https://clinicaltrials.gov/study/NCT05703997
Namgung Y, Lee K, Choi J, et al. (2023) ‘’Role of atezolizumab in controlling CNS progression in ES-SCLC.’’ Presented at ESMO ASIA 2023 (520P).
