ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1562458
This article is part of the Research TopicThe Application of Immune Checkpoint Inhibitors Combined with Chemotherapy in Tumor ImmunotherapyView all 19 articles
Efficacy and safety of first-line chemotherapy combined with immune checkpoint inhibitors for extensive-stage small cell lung cancer patients: a real-world propensity score matching study
Provisionally accepted
Bin Jia1Chenyi Zhou1Fei Zhao2Xiaoru Song2Yuan Ding2Xiyin Wang1Boying Wu1Huina Wang2Quanman Hu2*
Shuaiyin Chen2*- 1First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- 2Zhengzhou University, Zhengzhou, Henan Province, China
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Background: extensive-stage small cell lung cancer (ES-SCLC) were the majority of SCLC patients. Recently the combination of chemotherapy with immune checkpoint inhibitors (ICIs) have emerged as the new first-line treatment standard for ES-SCLC.However, the specific patient populations that are most likely to benefit from this treatment remains to be clearly identified making the establishment of baseline biomarkers critical.. Methods: We recruited ES-SCLC patients who were treated at the First Affiliated Hospital of Zhengzhou University and conducted a propensity score-matched analysis (PSM). And used the Kaplan-Meier (K-M) method and Cox proportional hazards regression to compare the survival outcomes. In addition, univariate and multivariate COX regression analyses were conducted to identify predictors.Results: After-PSM, chemotherapy group had a longer median overall survival (mOS) of 15.23 months (95%CI: 14.00-17.87) and hazard ratio (HR) of 0.576 (95% confidence interval (CI): 0.404-0.821), P=0.002), and the median progression free survival (mPFS) in the chemotherapy group was shorter: 6.05months (95%CI: 4.33-7.87), HR=0.707 (95%CI: 0.526 -0.950, P=0.021) compared to before PSM. Multivariate analysis confirmed that Eastern Cooperative Oncology Group performance status (ECOG PS) =1 (HR: 2.36, 95% CI: 1.38-4.03, P=0.002) and brain metastases (HR: 2.08, 95% CI:1.05-4.14, P=0.038) were independent prognostic factors for PFS, and only systemic inflammation response index (SIRI)> 2.63 (HR: 0.06, 95% CI: 0.01-0.29, P<0.001) was an independent prognostic factor for OS. Conclusion: our findings indicate that incorporating ICIs into first-line chemotherapy significantly improves PFS and OS in ES-SCLC patients, while maintaining safety. Moreover, poor ECOG PS, brain metastases, and high SIRI at baseline may serve as valuable prognostic indicators for disease progression and survival in ES-SCLC patients undergoing first-line chemotherapy plus ICIs. It is worth noting that these findings should be interpreted as hypothesis-generating, not definitive clinical conclusions.
Keywords: ES-SCLC, chemotherapy, ICIS, PSM, COX, prognostic
Received: 17 Jan 2025; Accepted: 28 Jul 2025.
Copyright: © 2025 Jia, Zhou, Zhao, Song, Ding, Wang, Wu, Wang, Hu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Quanman Hu, Zhengzhou University, Zhengzhou, 450001, Henan Province, China
Shuaiyin Chen, Zhengzhou University, Zhengzhou, 450001, Henan Province, China
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