Treatment of relapsed small cell lung cancer in the real-world: A comparison of platinum-etoposide rechallenge and cyclophosphamide-doxorubicin-vincristine (CAV) chemotherapy.
Notice bibliographique
Résumé
e20123 Background: Small-cell lung cancer (SCLC) is an aggressive malignancy, representing 15% of all diagnosed lung cancers. Initial therapy involves platinum-based chemotherapy, with recent evidence supporting the addition of immunotherapy. Despite excellent initial response to treatment, relapses are common and there is little prospective evidence available to guide second-line therapy. Depending on response to the previous regimen, second-line treatment can involve platinum-etoposide (PE) re-challenge or other therapies including CAV (cyclophosphamide-doxorubicin-vincristine), topotecan, taxanes, or immunotherapy. Methods: We reviewed all patients diagnosed with SCLC at the Ottawa Hospital from January 2014 – December 2021, and identified those treated with second-line systemic therapy. Baseline demographics, diagnostic, and treatment information were collected. The primary outcome was overall survival compared between platinum-etoposide re-challenge and CAV. Results: During the study period, 680 patients were diagnosed with SCLC, 521(76%) received first-line systemic therapy, and 161/521 (31%) went on to receive second-line systemic therapy. Baseline characteristics at initial diagnosis of this second-line cohort: median age 64, 93 (58%) female, 156 (97%) former/current smoking history, 156 (97%) extensive-stage. First-line treatment was almost exclusively platinum-based (n = 154, 96%). At the time of second-line therapy: 105 (69%) had ECOG performance status (PS) 0-1, and 103 (64%) had chemosensitive disease with a treatment-free interval (TFI) > 90 days. Second-line regimens included platinum-etoposide (n =64, 43%), CAV (n =67, 41%), platinum-irinotecan (n =3, 2%), docetaxel (n =10, 6%), and other (n =12, 7%). Median overall survival from the start of second line chemotherapy was 5.7 months (95% CI 5.0-6.4). Comparing patients who received PE-re-challenge versus CAV, there were no significant differences in age, sex, smoking history, or stage at diagnosis. Patients receiving CAV were more likely to have a lower performance status (ECOG >2: 40% versus 23%, p = 0.04) have a TFI < 180 days (81% vs 62%, p = 0.002). PE chemotherapy led to higher physician-assessed clinical benefit (83% vs 55%, p < 0.001) and median overall survival (7.3 (95% CI 5.7 – 8.8) versus 4.1 (95% CI 2.8 – 5.4 months), p < 0.001) compared to those receiving CAV. In a sensitivity analysis for patients with TFI < 180 days, PE-re-challenge had a higher mOS than CAV (6.2 (95% CI 5.1-7.2) versus 4.1 (95% CI 3.0 - 5.2), p < 0.003). Conclusions: Patients who receive second-line systemic therapy for relapsed SCLC represent a small subset of the overall SCLC patient population. In this real-world study, platinum-etoposide re-challenge appeared to offer benefit over CAV, even in patients with PFI < 180 days.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».