Immunotherapy, especially immune checkpoint inhibitor, has been revolutionizing cancer treatments and has been an active area of investigation in SCLC as well. PD-1 immune checkpoint inhibitor antibodies nivolumab31 and pembrolizumab32,33 exhibited promising efficacy for SCLC and were available to Chinese patients. In our series, 11 patients received immunotherapy of PD-1 immune checkpoint inhibitor after completion of chemotherapy in department of medical oncology. Our results showed that OS time increased in patients who received immunotherapy (9 months vs 6 months), and multivariate analysis confirmed that immunotherapy was an independent prognostic factor.
SCLC is very chemosensitive and, therefore, the standard treatment for patients with SCLC is combination chemotherapy.3,34 Unfortunately, although 35–86% of patients respond to first-line chemotherapy of platinum-etoposide doublet, disease relapses rapidly, and outcomes with second-line treatment of topotecan or amrubicin are poor.31 In our series, intraoperative chemotherapy was used for selected patients under the hypothesis that local accumulation of anticancer agents leads to enhanced efficacy with decreased systemic toxicity. Postoperatively, all patients were transferred to department of medical oncology, and received chemotherapy performed by our multidisciplinary team except for the two who had the poor general condition after surgery. Radiotherapy represents the major treatment of patients with spinal metastases. New advances in radiation technology, such as spine stereotactic body radiotherapy, have allowed delivery of higher doses of radiation to the target volume with minimal injury to surrounding tissue. In our series, because the presence of SCC was oncological emergency, prompt surgical decompression rather than radiotherapy was the first choice of treatment. Radiotherapy was performed postoperatively in 12 patients. Our results showed that a longer OS was achieved in both patients who received systemic chemotherapy (9 months vs 4 months) and patients who received postoperative radiotherapy (12 months vs 6 months). But largely due to the limited sample size, these differences were not statistically significant. Other therapies, such as bisphosphonate treatment, surgery and radiotherapy for lung were also failed to show their significant improvements for OS in our series, and their efficacy needs further investigations.
Several limitations of this study should be mentioned. Firstly, the retrospective nature is the main limitation. Secondly, all patients enrolled in this series received surgical intervention. There was no control group treated without surgery. Thirdly, we did not design subgroups for analyses of chemotherapy and immunotherapy based on detailed therapeutic schemes due to the limited sample size. Fourthly, it is also because of the small sample size, we failed to analyze the risk factors for postoperative complications in depth.
In conclusion, through analysis of 30 consecutive patients surgically treated for metastatic SCC from SCLC, we concluded that despite the short life expectancy, prompt surgical decompression is extremely necessary for patients with SCC caused by SCLC, for surgery played a critical role in improving patients’ QoL. Postoperative ECOG-PS of 0–2 and immunotherapy were identified to be favorable prognostic factors for OS. Consideration of these findings might be helpful in treating patients with metastatic SCC from SCLC. A promising outcome might be achieved by timely surgical intervention followed by standard chemotherapy and further immunotherapy for selected patients.
Shanghai Municipal Science and Technology Commission 10.13039/501100003399 This work was supported by key project funding in the basic research field of the Shanghai Municipal Science and Technology Commission (17JC1400903).
The authors declare that they have no conflicts of interest in this work.
Xin Gao,1,* Kun Zhang,1,* Shuang Cao,1,2,* Shuming Hou,1,* Tao Wang,1 Wen Guo,1,3 Zheyu Wu,1,4 Qi Jia,1 Tielong Liu,1 Jianru Xiao1
1Orthopaedic Oncology Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 2Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People’s Republic of China; 3Department of Orthopedics, Taizhou People’s Hospital, Taizhou, Jiangsu Province, People’s Republic of China; 4Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tielong Liu; Jianru Xiao
Orthopaedic Oncology Center, Department of Orthopaedics, Changzheng Hospital, No. 415 Fengyang Road, Huangpu District, Shanghai, People’s Republic of China
Email [email protected]; [email protected]
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Source: Cancer Management and Research.
Originally published May 19, 2020.
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