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Outcomes of first-line anti-PD-L1 blockades combined with brain radiotherapy for extensive-stage small-cell lung cancer with brain metastasis

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Abstract

Introduction

Anti-programmed cell death-ligand 1 (Anti-PD-L1) blockades have become the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC) from CASPIAN and IMpower133 trials. SCLC has a high incidence of brain metastasis (BM) and brain radiotherapy (BRT) is the main local treatment method, but there is limited data on the BRT-immunotherapy scheme. The aim of the retrospective study is to investigate the clinical efficacy and safety of the first-line anti-PD-L1 blockades combined with BRT in ES-SCLC with BM.

Methods

Patients with newly diagnosed ES-SCLC with baseline BMs at Shandong Cancer Hospital and Research Institute between 2017 and 2021 were selected. Patients were divided into the anti-PD-L1+BRT group and BRT group. We also assessed the leukoencephalopathy in both groups.

Results

A total of 46 patients were selected. Fifteen were divided into anti-PD-L1+BRT group and 31 to BRT group. The median overall survival (OS) was not reached (NR) vs 15.9 m (P = 0.172). Progression-free survival (PFS) was numerically prolonged with anti-PD-L1 blockades, but the significance was not reached (median: 9.4 m vs 7.4 m, P = 0.362). The median intracranial PFS was not improved, neither (median: 8.2 m vs 8.9 m, P = 0.620). Objective response rate (ORR) in the two groups was 73.33% vs 77.42% (P = 0.949) and disease control rate (DCR) was both 100%. Intracranial ORR and DCR were 53.33% vs 70.97% (P = 0.239) and 73.33% vs 80.65% (P = 0.855), respectively. There was no significant difference in leukoencephalopathy incidence between the two groups.

Conclusion

The combination of first-line anti-PD-L1 blockades with BRT did not confer a significant survival benefit in ES-SCLC with BM, without enhancing cranial neurotoxicity.

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Data availability

The data are not available for public access because of patient privacy concerns but are available from the corresponding author on reasonable request approved by the institutional review boards of Shandong Cancer Hospital and Institute.

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Acknowledgements

Not applicable.

Funding

Yaru Tian has received grants from the foundation of National Natural Science Foundation of China (Grant No. 82103632) and the foundation of Natural Science Foundation of Shandong (Grant No. ZR2021QH245). Dongfang Meng has received grants from the foundation of Natural Science Foundation of Shandong (Grant No. ZR2021QH208). Hui Zhu has received grants from the foundation of National Natural Science Foundation of China (Grant No. 81972862).

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Contributions

JM and YT: Data Curation, Methodology, Formal analysis and Writing—Original Draft; SH: Revising the manuscript; LZ and WH: Validation and Investigation; XZ and DM: Writing—Review & Editing; HZ: Conceptualization and Supervision.

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Correspondence to Hui Zhu.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the Ethics Committee of Shandong Cancer Hospital and Institute and all patients provided written informed consent for use of their data.

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Ma, J., Tian, Y., Hao, S. et al. Outcomes of first-line anti-PD-L1 blockades combined with brain radiotherapy for extensive-stage small-cell lung cancer with brain metastasis. J Neurooncol 159, 685–693 (2022). https://doi.org/10.1007/s11060-022-04111-7

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