Background: The treatment landscape for extensive-stage small cell lung cancer (ES-SCLC) has evolved in recent years, including the approval of first-line immunotherapy and the continued evaluation of radiation therapy, however, limited real-world data on the use of these therapeutic options exist.
Objectives: The objective of this analysis was to evaluate treatment patterns and clinical outcomes among patients with ES-SCLC in a real-world setting.
Methods: Patients (≥18 years) diagnosed with lung cancer between January 1, 2019, and June 30, 2024, were analyzed from NorstellaLinQ, a US dataset that contains administrative claims for over 170 million patients across commercial payers, Medicare Advantage and Medicaid. Eligible patients had continuous health plan enrollment for at least six months before and after diagnosis, with no prior malignancy during the baseline period. Patients were identified as having ES stage disease if they received platinum-doublet chemoimmunotherapy as their first line of therapy after their cancer diagnosis. Treatment patterns and clinical outcomes, including new primary malignancies, brain metastases, and frailty during post-index period were analyzed descriptively.
Results: A total of 853 patients with ES-SCLC were included. The mean age was 62.6 years, with a majority being female (57.7%), residing in Southern states at diagnosis (31.0%), and covered by Medicaid (47.0%). After first-line therapy, approximately 37% transitioned to immunotherapy alone (93% atezolizumab) and15% received topotecan as second line of therapy. Overall, 15.1% underwent radiation therapy following first-line treatment, with equal distribution between males and females. The majority (64.71%) had their cancer metastasize to the brain, and 57.8% of patients were frail. Additionally, over one-third developed a second primary malignancy, with a median time to diagnosis of 3.1 months.
Conclusions: Despite new therapeutic options in recent years, ES-SCLC patients still experience poor clinical outcomes, with high rates of brain metastasis, frailty, and the development of new malignancy.
