Real-world effectiveness and tolerability of small-cell lung cancer (SCLC) treatments: A systematic literature review (SLR)

Abstract

Objectives SCLC makes up approximately 15% of all lung carcinomas and is characterized by relatively aggressive spread and poorer prognosis compared to other lung cancers. Treatment options are limited, and their efficacy in randomized trials is poor, whilst outcomes in clinical practice remain unclear. The aim of this study was to assess the real-world effectiveness and tolerability of SCLC treatments. Methods An SLR was conducted across nine databases accessed through OVID, capturing observational, non-randomized studies published between 01/2006–11/2018. In total, 554 abstracts were retrieved and systematically screened for eligibility. The eligible publications included effectiveness and tolerability data from adult SCLC patients (at any line of therapy). Additional grey literature searches were conducted. Results Forty-three publications were included in this review—data from first-line therapies were captured most often (n = 32), while data from second (n = 14) and third line (n = 7) and beyond (n = 7) were less frequent. The publications reported primarily on chemotherapy/radiotherapy. The majority of publications lacked robustness and only 14/43 conducted statistical analyses or controlled for bias. Median OS for the largest SCLC populations were 9.6 months at first line (n = 23,535) and 4.9 months at second line (n = 254) for treatment with chemotherapy, and 4.7 months at third line (n = 120) for predominantly platinum-based chemotherapy or cyclophosphamide/adriamycin/vincristine. Hematologic toxicities (such as neutropenia, thrombocytopenia and anemia) were the most frequently reported TRAEs (n = 9). Conclusions Real-world treatment effectiveness and tolerability data were fragmented and inconsistently reported, and available publications were primarily of poor quality and lacked statistical analyses. This SLR showed limited treatment options and poor OS in SCLC, with no treatment option being clearly superior. TRAEs additionally increased the burden of this already challenging disease. Recent data suggest real-world outcomes are even poorer that those reported in clinical trials, and that novel therapies are needed to offer new treatment options for patients.

Real‐world treatment patterns and outcomes of patients with extensive disease small cell lung cancer

“…A recent systematic literature review on real‐world effectiveness of SCLC treatments by Povsic et al also emphasized the limited number of treatment options in SCLC and lack of good quality real‐world data about outcomes (Povsic et al., 2019). The aim of the present study is to provide good quality data on treatment patterns, including best supportive care, and corresponding survival times in an unselected patient population with ED SCLC.…”

Role of Focal Adhesion Kinase in Small-Cell Lung Cancer and Its Potential as a Therapeutic Target

“…At relapse or progression after a first-line treatment, a rechallenge with platinum and etoposide is proposed to tumors that are considered to be sensitive to platinum (relapse or progression within 60 or 90 days of completion of chemotherapy) [18], while a second-line chemotherapy with topotecan is proposed to tumors platinum-refractory (relapse or progression before three to six months). However, the response rates are poor and OS ranges from 1.2 months to 7.6 months based on systematic reviews of real-world data 15 [19]. These disappointing results highlight the need for novel therapies.…”

Antitumor activity of lurbinectedin in second-line small cell lung cancer patients who are candidates for re-challenge with the first-line treatment

“…Subset analysis of 31 patients undergoing second-line re-treatment with a platinum-based regimen after a median CTFI of 6.6 months, including 55 % with CTFI ≥ 90 days, demonstrated an ORR of 38.7 % and median OS of 8.0 months (95 %CI, 6.8-16.5 months). A systematic literature review on real-world effectiveness and tolerability of SCLC treatments showed a median OS of 6.3 months for patients with sensitive disease treated with chemotherapy as second-line [28]. Overall, lurbinectedin data compares favorably with respect to these real-world figures.…”