{
  "abstract": "Background Extensive-stage small cell lung cancer (ES-SCLC) is characterized by rapid disease progression and limited long-term survival. For decades, platinum-etoposide (EP) chemotherapy yielded high initial response rates, but relapse was nearly universal. More recently, the addition of immunotherapy—durvalumab or atezolizumab—to first-line chemotherapy has improved patient outcomes and is now an established standard of care, based on the pivotal CASPIAN and IMpower133 trials. 1 2 However, a major limitation of these trials is their strict eligibility criteria, which excluded patients with comorbidities and poor performance status, features common in Veteran patients. Consequently, the results may not be generalizable to the Veteran population. To address this gap, our study evaluates the effectiveness of chemotherapy and immunotherapy (chemo/IO) in Veterans with ES-SCLC.Methods We utilized the Veterans Affairs (VA) Corporate Data Warehouse (CDW) to identify patients diagnosed with ES-SCLC between 2015-2023 across the national VA system. Demographic information (age, sex, race/ethnicity, and comorbidities) and cancer-specific information including diagnosis year, clinical stage, and treatments (surgery, radiation, chemotherapy, and immunotherapy) were collected using combined registry and claims data. Participants were matched by propensity score (PS) and radiotherapy receipt to address potential selection bias when comparing chemo/IO and chemotherapy alone. PS was estimated using logistic regression incorporating demographics, stage, and comorbidity index. The primary outcome was overall survival (OS), defined as time from diagnosis to death from any cause. Survival was compared using Kaplan-Meier and Cox proportional hazards models. Statistical analyses were performed using SAS 9.4 (SAS Institute, Cary, NC).Results We identified 1,909 Veterans diagnosed with ES-SCLC between 2015-2023. Among them, 1254 (65.7%) were treated between 2015-2018 and received chemotherapy alone; 655 (34.3%) were treated between 2020-2023 and received chemo/IO. Among patients treated with immunotherapy, 563 (87.4%) received atezolizumab; 61 (9.5%) received durvalumab. We found that the median OS was 9 months vs 7.2 months (p <0.0001) in patients who received chemo/IO vs chemotherapy alone. The 3-year survival was 5.5% vs 3.3% (p<0.0001, chemo/IO vs chemo alone; figure 1).Conclusions Although Veterans derived benefit from the addition of immunotherapy to standard chemotherapy, our study revealed a marked disparity in long-term survival compared to outcomes reported in PCTs. These findings were confirmed through propensity-matched analysis that accounted for potential selection bias that may have occurred as standard of care evolved. To our knowledge, this is the largest outcomes study of Veterans with ES-SCLC, underscoring the need for future trials with broader eligibility criteria to better reflect real-world populations.References Reck M, Dziadziuszko R, Sugawara S, et al. Five-year survival in patients with extensive-stage small cell lung cancer treated with atezolizumab in the phase III IMpower133 study and the Phase III IMbrella a extension study. Lung Cancer. 2024;196:107924. doi:10.1016/j.lungcan.2024.107924Paz-Ares L, Chen Y, Reinmuth N, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer: 3-year overall survival update from CASPIAN. ESMO Open. 2022;7(2):100408. doi:10.1016/j.esmoop.2022.100408Ethics Approval The study protocol was reviewed and approved by the Institutional Review Board of the James J. Peters VA Medical Center.Abstract 409 Figure 13-year survival analysis. The 3-year survival was 5.5% vs 3.3% (p<0.0001, chemo/IO vs chemo alone)",
  "authors": [
    {
      "affiliations": [
        "Columbia University, New York City, NY, USA"
      ],
      "name": "Jason Cham"
    },
    {
      "affiliations": [
        "Icahn School of Medicine at Mount Sinai, New York City, NY, USA"
      ],
      "name": "Eunyoung Yang"
    },
    {
      "affiliations": [
        "Columbia University Irving Medical Center, New York City, NY, USA",
        "James J. Peters Department of Veterans Affairs Medical Center, New York City, NY, USA"
      ],
      "name": "Antonio T Fojo"
    },
    {
      "affiliations": [
        "Icahn School of Medicine at Mount Sinai, New York City, NY, USA"
      ],
      "name": "Keith Sigel"
    },
    {
      "affiliations": [
        "Columbia University Irving Medical Center, New York City, NY, USA",
        "James J. Peters Department of Veterans Affairs Medical Center, New York City, NY, USA"
      ],
      "name": "Susan E Bates"
    }
  ],
  "title": "409 Real-world outcomes for patients with extensive-stage small cell lung cancer treated with chemo-immunotherapy in the veterans affair system",
  "uid": "a5f496eb-4fc9-5733-9598-4ad64954af73"
}