About 13% of lung cancer patients have Small Cell Lung Cancer (SCLC). The prognosis of this disease is very poor with 5-year survival rates of 31% for limited-stage SCLC (LS-SCLC) and 2% for extensive-stage SCLC (ES-SCLC). However, recent studies have shown that anti PD-L1 antibodies can extend overall survival of ES-SCLC patients when combined with platinum-etoposide treatment.
Professor Benjamin Besse, Head of the Cancer Medicine Department at Gustave Roussy Cancer Campus and Professor of Medical Oncology at Paris-Saclay University, Orsay, presented the late breaking data from EORTC-1417-LCG REACTION study: a phase II study of etoposide and cis/carboplatin with or without pembrolizumab in untreated extensive small cell lung cancer at the ESMO Virtual congress today.
All 125 patients (61 in experimental vs 64 in control arm) recruited previously responded to 2 cycles of platinum-etoposide. They were randomized into the control arm of 4 additional cycles of platinum-etoposide treatment or the experimental arm with 4 additional cycles of platinum-etoposide treatment combined with pembrolizumab and then up to 35 cycles of pembrolizumab. 119 (58 vs 61) patients were eligible and started at least one dose of the treatment. 19 patients had crossed over to the experimental arm at the time of progression. In the experimental arm, 43 % exhibited grade 3 to 5 adverse events vs 36% in the standard arm, median progression free survival was 4.7 vs. 5.4 months and overall survival was 12.3 vs 10.4 months respectively. Besse concluded that even though the combination of etoposide and platinum with pembrolizumab was well tolerated, it did not improve progression free survival compared to standard treatment. However, the data did elude to the potential increase in overall survival, it should be noted that pembrolizumab needs to be introduced as first line treatment in order to benefit from this improvement.
“In REACTION, immunotherapy was added from the third cycle of chemotherapy,” said Besse. “Our results confirm the benefit of adding immunotherapy to first line chemotherapy in patients with extended SCLC. Our strategy is interesting for patient with PS2 at cycle 1 (thus unfit for immunotherapy) that will improve to PS 1 or 0 at cycle 3”.
Mini Oral Session – Non-metastatic NSCLC and other thoracic malignancies
LATE BREAKING ABSTRACT: REACTION: A phase II study of etoposide and cis/carboplatin with or without pembrolizumab in untreated extensive small cell lung cancer
- Presentation Number: LBA85
- Date: 18 September 2020
- Speaker: Benjamin Besse (Villejuif, CEDEX, France)