Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer

Abdülkadir Koçanoğlu; Oktay Ünsal; İbrahim Karadağ; Fırat Şirvan; Serdar Karakaya

doi:10.19161/etd.1977604

TR EN

Yaygın evre küçük hücreli akciğer kanserinde birinci basamak karboplatin–etoposid–atezolizumab tedavisinin gerçek yaşam sonuçları

Öz

Amaç: Atezolizumabın platin-etoposid kemoterapisine eklenmesi, yaygın evre küçük hücreli akciğer kanserinde (YE-KHAK) standart birinci basamak tedavi haline gelmiştir. Ancak gerçek yaşam verileri ve prognostik faktörlere ilişkin bilgiler sınırlıdır. Bu çalışmada, birinci basamak karboplatin-etoposid-atezolizumab tedavisinin gerçek yaşam sonuçları ile klinik ve PET/BT kaynaklı prognostik faktörler değerlendirildi. Gereç ve Yöntem: Ocak 2022-Aralık 2025 tarihleri arasında birinci basamak karboplatin, etoposid ve atezolizumab tedavisi alan 59 YE-KHAK hastası retrospektif olarak incelendi. Progresyonsuz sağkalım (PSK) ve genel sağkalım (GSK) Kaplan-Meier yöntemiyle analiz edildi. GSK ile ilişkili prognostik faktörler tek ve çok değişkenli Cox regresyon analizleriyle değerlendirildi. Bulgular: Medyan PSK 6,1 ay (%95 GA, 5,6–6,6), medyan GSK ise 8,9 ay (%95 GA, 6,9–10,9) olarak bulundu. ECOG performans skoru (PS) 0–1 olan hastalarda hem PSK (6,3 vs. 4,9 ay; p=0,001) hem de GSK (13,9 vs. 6,5 ay; p=0,002), ECOG PS 2–3 olan hastalara göre anlamlı olarak daha uzundu. Çok değişkenli analizde ECOG PS, GSK için bağımsız prognostik faktör olarak saptandı (HR 2,104; %95 GA 1,183–3,741; p=0,016). Beyin, karaciğer ve kemik metastazları, profilaktik kraniyal ışınlama durumu ile PET/BT'den elde edilen nodal ve metastatik SUVmax değerleri sağkalımla ilişkili bulunmadı. Sonuç: Gerçek yaşam verilerine dayanan bu çalışmada, birinci basamak karboplatin-etoposid-atezolizumab tedavisi alan YE-KHAK hastalarında genel sağkalımı öngören tek bağımsız prognostik faktör ECOG performans skoru olmuştur. PET/BT metabolik parametrelerinin prognostik katkı sağlamaması, kemoimmünoterapi döneminde klinik değerlendirmenin önemini koruduğunu göstermektedir.

Anahtar Kelimeler

Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer

Öz

Aim: The addition of atezolizumab to platinum-etoposide chemotherapy has become the standard first-line treatment for extensive-stage small-cell lung cancer (ES-SCLC). However, real-world data regarding treatment outcomes and prognostic factors remain limited. This study evaluated the effectiveness of first-line carboplatin-etoposide-atezolizumab and investigated clinical and PET/CT-derived prognostic factors in patients with ES-SCLC. Materials and Methods: We retrospectively analyzed 59 consecutive patients with ES-SCLC who received first-line carboplatin, etoposide, and atezolizumab between January 2022 and December 2025. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Prognostic factors for OS were evaluated using univariate and multivariable Cox proportional hazards regression analyses. Results: The median PFS and OS were 6.1 months (95% CI, 5.6–6.6) and 8.9 months (95% CI, 6.9–10.9), respectively. Patients with ECOG performance status (PS) 0–1 had significantly longer PFS (6.3 vs. 4.9 months, p=0.001) and OS (13.9 vs. 6.5 months, p=0.002) than those with ECOG PS 2–3. In multivariable analysis, ECOG PS remained the only independent prognostic factor for OS (HR 2.104, 95% CI 1.183–3.741; p=0.016). Brain, liver, and bone metastases, prophylactic cranial irradiation status, and PET/CT-derived nodal and metastatic SUVmax values were not significantly associated with survival. Conclusions: In this real-world cohort of patients with ES-SCLC treated with first-line carboplatin-etoposide-atezolizumab, ECOG performance status was the only independent prognostic factor for overall survival. PET/CT-derived metabolic parameters did not demonstrate prognostic value, emphasizing the continued importance of simple clinical assessment in the chemoimmunotherapy era.

Anahtar Kelimeler

Kaynakça

1. Wang X, Chiang AC. Big Decisions on Small Cell Lung Cancer: A Focus on Clinical Care Updates and Patient Perspectives. American Society of Clinical Oncology Educational Book. 2024;44(3):e432520.
2. Shalata W, Naamneh R, Najjar W, Asla M, Abu Gameh A, Abu Amna M, et al. Current and Emerging Therapeutic Strategies for Limited- and Extensive-Stage Small-Cell Lung Cancer. Med Sci (Basel). 2025;13(3).
3. Barba A, Martínez-Recio S, Portu M, Soto-Cambres AM, Trujillo JC, Farré N, Majem M. Small cell lung cancer: a therapeutic update in the era of immunotherapy and beyond—a narrative review. Chinese Clinical Oncology. 2026;15(2):34.
4. Horn L, Mansfield Aaron S, Szczęsna A, Havel L, Krzakowski M, Hochmair Maximilian J, et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. New England Journal of Medicine. 2018;379(23):2220-9.
5. Paz-Ares L, Dvorkin M, Chen Y, Reinmuth N, Hotta K, Trukhin D, et al. Durvalumab plus platinum–etoposide versus platinum–etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. The Lancet. 2019;394(10212):1929-39.
6. Wu Y, Zhang J, Zhou W, Yuan Z, Wang H. Prognostic factors in extensive-stage small cell lung cancer patients with organ-specific metastasis: unveiling commonalities and disparities. Journal of Cancer Research and Clinical Oncology. 2024;150(2):74.
7. Jiang X, Wang Z, Zhang X, Xie L, Ji S, Song Q, et al. A SEER prognostic nomogram analysis for extensive-stage small cell lung cancer: comparing the immune checkpoint inhibitors (ICIs) and non-ICIs eras. Journal of Thoracic Disease. 2025;17(5):2866-87.
8. Zhou J-X, Sun Y-C, Xiao L, Lu H-L, Yin X-M, Fan K, Zhou Y-N. Efficacy analysis and prognostic factors of first-line chemotherapy combined with immunotherapy in extensive-stage small cell lung cancer: a real-world study. Scientific Reports. 2025;15(1):13063.

9. Tang L, Tian G, Li N. Current dilemma and future directions over prophylactic cranial irradiation in SCLC: a systematic review in MRI and immunotherapy era. Frontiers in Oncology. 2024;Volume 14 - 2024.
10. Zhou S, Zhai W, Zhang Q, Li H, Fan Y. Impact of prophylactic cranial irradiation on survival in extensive-stage small cell lung cancer receiving first-line chemoimmunotherapy: a propensity score-matched study. Ther Adv Med Oncol. 2025;17:17588359251341158.
11. Christensen TN, Andersen PK, Langer SW, Fischer BMB. Prognostic Value of 18F–FDG–PET Parameters in Patients with Small Cell Lung Cancer: A Meta-Analysis and Review of Current Literature. Diagnostics. 2021;11(2):174.
12. Li M, Min M, Deng F. Real-world evaluation of immunotherapy in multi-line treatment of small cell lung cancer. Curr Med Res Opin. 2026;42(1):99-118.
13. Sun M, Ji H, Deng F, Li J, Xu N, Li Y. Clinical outcomes and synergistic effect between radiotherapy and immunotherapy in patients with extensive-stage small cell lung cancer: a real-world study. BMC Cancer. 2024;24(1):1206.
14. Tomic K, Begagic E, Voloder E, Naletilic MP, Jozic GB, Cale S, et al. Outcomes of extensive-stage small cell lung cancer treatment in a real-world clinical setting: a single-center experience. Contemp Oncol (Pozn). 2025;29(3):271-80.
15. Liu SV, Reck M, Mansfield AS, Mok T, Scherpereel A, Reinmuth N, et al. Updated Overall Survival and PD-L1 Subgroup Analysis of Patients With Extensive-Stage Small-Cell Lung Cancer Treated With Atezolizumab, Carboplatin, and Etoposide (IMpower133). J Clin Oncol. 2021;39(6):619-30.
16. Paz-Ares L, Chen Y, Reinmuth N, Hotta K, Trukhin D, Statsenko G, 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.
17. Wang J, Zhou C, Yao W, Wang Q, Min X, Chen G, et al. Adebrelimab or placebo plus carboplatin and etoposide as first-line treatment for extensive-stage small-cell lung cancer (CAPSTONE-1): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2022;23(6):739-47.
18. Cheng Y, Han L, Wu L, Chen J, Sun H, Wen G, et al. Effect of First-Line Serplulimab vs Placebo Added to Chemotherapy on Survival in Patients With Extensive-Stage Small Cell Lung Cancer: The ASTRUM-005 Randomized Clinical Trial. Jama. 2022;328(12):1223-32.
19. Huang L, Hu X, Wang Y. Survival and pretreatment prognostic factors for extensive-stage small cell lung cancer: a comprehensive analysis of 358 patients. Thorac Cancer. 2021; 12 (13): 1943–51.
20. Bria E, Morgillo F, Garassino MC, Ciardiello F, Ardizzoni A, Stefani A, et al. Atezolizumab plus carboplatin and etoposide in patients with untreated extensive-stage small-cell lung cancer: interim results of the MAURIS phase IIIb trial. The Oncologist. 2024;29(5):e690-e8.
21. Sonusen SD, Isleyen ZS, Satis NA, Yilmaz M, Dogan B, Gunenc S, et al. Prognostic factors and survival outcomes in older adults with extensive-stage small cell lung cancer: A multicenter retrospective cohort study. Medicine. 2026;105(19):e48711.
22. Reed N, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). European Journal of Cancer. 2008;44(6):808-18.
23. Takahashi T, Yamanaka T, Seto T, Harada H, Nokihara H, Saka H, et al. Prophylactic cranial irradiation versus observation in patients with extensive-disease small-cell lung cancer: a multicentre, randomised, open-label, phase 3 trial. The Lancet Oncology. 2017;18(5):663-71.
24. Choi EK, Park M, Im JJ, Chung Y-A, Oh JK. Prognostic value of 18F-FDG PET/CT metabolic parameters in small cell lung cancer. Journal of International Medical Research. 2020;48(4):0300060519892419.
25. Nie K, Zhang YX, Nie W, Zhu L, Chen YN, Xiao YX, et al. Prognostic value of metabolic tumour volume and total lesion glycolysis measured by 18F‐fluorodeoxyglucose positron emission tomography/computed tomography in small cell lung cancer: a systematic review and meta‐analysis. Journal of Medical Imaging and Radiation Oncology. 2019;63(1):84-93.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Klinik Onkoloji

Bölüm

Araştırma Makalesi

Yazarlar

Abdülkadir Koçanoğlu
0000-0002-5579-2135
Türkiye

Oktay Ünsal
0000-0002-3215-8457
Türkiye

İbrahim Karadağ
0000-0002-2356-6790
Türkiye

Fırat Şirvan ^*
0009-0004-8210-0837
Türkiye

Serdar Karakaya
0000-0002-2111-7131
Türkiye

Yayımlanma Tarihi

3 Eylül 2026

Gönderilme Tarihi

23 Haziran 2026

Kabul Tarihi

28 Temmuz 2026

Yayımlandığı Sayı

Yıl 2026 Cilt: 65 Sayı: 3

DOI

https://doi.org/10.19161/etd.1977604

IZ

https://izlik.org/JA77PG62UG

Kaynak Göster

RIS / Bibtex

APA

Koçanoğlu, A., Ünsal, O., Karadağ, İ., Şirvan, F., & Karakaya, S. (2026). Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer. Ege Tıp Dergisi, 65(3), 572-580. https://doi.org/10.19161/etd.1977604

AMA

1.Koçanoğlu A, Ünsal O, Karadağ İ, Şirvan F, Karakaya S. Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer. ETD. 2026;65(3):572-580. doi:10.19161/etd.1977604

Chicago

Koçanoğlu, Abdülkadir, Oktay Ünsal, İbrahim Karadağ, Fırat Şirvan, ve Serdar Karakaya. 2026. “Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer”. Ege Tıp Dergisi 65 (3): 572-80. https://doi.org/10.19161/etd.1977604.

EndNote

Koçanoğlu A, Ünsal O, Karadağ İ, Şirvan F, Karakaya S (01 Eylül 2026) Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer. Ege Tıp Dergisi 65 3 572–580.

IEEE

[1]A. Koçanoğlu, O. Ünsal, İ. Karadağ, F. Şirvan, ve S. Karakaya, “Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer”, ETD, c. 65, sy 3, ss. 572–580, Eyl. 2026, doi: 10.19161/etd.1977604.

ISNAD

Koçanoğlu, Abdülkadir - Ünsal, Oktay - Karadağ, İbrahim - Şirvan, Fırat - Karakaya, Serdar. “Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer”. Ege Tıp Dergisi 65/3 (01 Eylül 2026): 572-580. https://doi.org/10.19161/etd.1977604.

JAMA

1.Koçanoğlu A, Ünsal O, Karadağ İ, Şirvan F, Karakaya S. Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer. ETD. 2026;65:572–580.

MLA

Koçanoğlu, Abdülkadir, vd. “Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer”. Ege Tıp Dergisi, c. 65, sy 3, Eylül 2026, ss. 572-80, doi:10.19161/etd.1977604.

Vancouver

1.Abdülkadir Koçanoğlu, Oktay Ünsal, İbrahim Karadağ, Fırat Şirvan, Serdar Karakaya. Real-world outcomes of first-line carboplatin–etoposide–atezolizumab in extensive-stage small-cell lung cancer. ETD. 01 Eylül 2026;65(3):572-80. doi:10.19161/etd.1977604