Abstract
BACKGROUND: Patients with small-cell lung cancer (SCLC) primarily present with extensive stage (ES) disease and poor 5-year survival. There are few treatment options and limited data on outcomes in third-line (3L) ES SCLC to quantify unmet medical needs. This chart review evaluated real-world (RW) clinical outcomes and treatment patterns in these patients. METHODS: This retrospective study using electronic medical records included adult patients with ES SCLC (≥ 2 claims for metastasized lung cancer) who received ≥ 3 lines of therapy (LOT) at Cancer Treatment Centers of America (now City of Hope). Patients with other/multiple primary malignancies, non-SCLC histology, or treated through a clinical trial were excluded. Clinical outcomes included RW physician-reported response rates, duration of response (DOR), duration of clinical benefit (DoCB), overall survival (OS), and progression-free survival (PFS), stratified by platinum sensitivity and Eastern Cooperative Oncology Group performance status (ECOG-PS). Time-to-event outcomes were estimated via Kaplan-Meier. Treatment patterns were assessed, including the sequence of regimens by LOT and first-line (1L) platinum sensitivity status. RESULTS: Among 113 eligible patients (median age 58 years), 54% were female, and 46% had a chemotherapy-free interval after 1L of < 90 days. Tumor shrinkage, complete response, and stable disease were reported in 19%, 1%, and 13% of patients at 3L, respectively. The median DOR, DoCB, OS, and PFS were 2.8, 2.5, 5.8, and 2.4 months in 3L, respectively. Platinum-resistant versus sensitive patients in 1L had shorter time-to-event outcomes. Clinical outcomes were similar regardless of ECOG-PS status. Platinum-based chemotherapy rates decreased from 94% and 93% in 1L to 17% and 16% in 3L in platinum-sensitive and resistant patients, respectively. CONCLUSION: These RW findings validate 3L results from clinical trials, demonstrating the limited clinical benefits with current therapies in 3L ES SCLC, and highlighting the urgent need for novel therapies that improve outcomes in this difficult-to-treat patient population.