Pcn5 - Treatments of Radioiodine-Refractory Differentiated Thyroid Cancer in Routine Clinical Practice – A Systematic Review

Abstract

OBJECTIVES: SCLC accounts for approximately 15% of all lung cancers. Owing to its aggressive nature, its prognosis is worse than other lung carcinomas. Treatment options remain limited, and real-world SCLC treatment outcomes are not clear. The aim of this study was to explore the real-world effectiveness and tolerability of SCLC treatments through an SLR. METHODS: Using the OVID search engine, an SLR was conducted across multiple databases. Searches were limited to English language studies published between January 2006 and February 2018, and included observational, non-interventional studies only. In total, 445 abstracts were retrieved and systematically screened for eligibility. Eligible studies included adult SCLC patients and presented effectiveness and tolerability outcomes from a predefined list of treatments. Additional grey-literature searches were conducted. RESULTS: 1st-line therapies were captured most frequently (n¼10). 2nd-line therapies and beyond were less common (n¼4). No data were captured in 3rd line. Chemo-and radiotherapy were the only therapies reported; overall survival (OS) was the most frequently reported outcome. Median reported OS at 1st line was 16 months (95% CI: 13e25.9) for cisplatin/etoposide/ifosfamide + radiotherapy, 15.7 months (95% CI: 14.0e17.5) for cisplatin/etoposide. Median reported OS in 2nd-line chemotherapy was 5.3 months (95% CI: 4.9e5.8) and 3.8 months (95% CI: 3.5e4.1) for platinum-sensitive and refractory SCLC, respectively. For palliative chemotherapy administered across all lines, median reported OS was 7.3 months (95% CI: 3.3e8.8). Tolerability was reported in eight studies across 1st and 2nd line, with hematological toxicities (neutropenia, leukopenia, thrombocytopenia and anemia) the most frequently reported. CONCLUSIONS: Real-world treatment effectiveness and tolerability data are limited, particularly in 2nd-line therapy and beyond. OS in SCLC remains poor and the incidence of adverse events with treatment increases the burden of the disease. Novel therapies, such as immune-checkpoint inhibitors, may offer a new direction in SCLC management.