ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicAdvancing Next-Generation Immunotherapy and Biomarker Discovery: Pioneering the Future of Treatment Strategies in Solid TumorsView all 3 articles
Early C-Reactive Protein Reduction Predicts Survival in Real-World Extensive-Stage Small Cell Lung Cancer Treated with First-Line Adebrelimab-Based Immunotherapy
Provisionally accepted
- 1Quzhou City People's Hospital, Quzhou, China
- 2Changsha Medical University, Changsha, China
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Background: Extensive-stage small cell lung cancer (ES-SCLC) remains an aggressive malignancy with limited biomarkers for predicting outcomes in real-world settings. While baseline systemic inflammation correlates with prognosis, the role of longitudinal inflammation dynamics during PD-L1 inhibitor-based therapy is unexplored. This study investigated whether early changes in systemic inflammation markers, particularly C-reactive protein (CRP), predict clinical efficacy in ES-SCLC patients receiving first-line adebrelimab plus chemotherapy. Methods: In this retrospective, single-center study, 35 ES-SCLC patients (median age: 72 years) treated with adebrelimab plus platinum-etoposide or platinum-irinotecan chemotherapy were analyzed. Ten systemic inflammation markers (NLR, PLR, LMR, PAR, SII, NPR, CAR, CLR, CRP, LDH) were assessed at baseline and after 2 months of therapy. Inflammatory trends were quantified as the ratio of 2-month to baseline values. Associations between inflammation dynamics and survival (OS from 2 months, OS2) or radiologic response (RECIST 1.1) were evaluated using Kaplan-Meier analysis, Cox regression, and Spearman's correlation. Results: The cohort showed robust real-world efficacy (median OS: 15.0 months; ORR: 62.8%). Among ten inflammation markers analyzed, only CRP dynamics were significantly associated with OS in univariate analysis. Patients achieving CRP reduction (trend ratio <1) at 2 months had significantly longer median OS (16.2 months) versus those without reduction (8.1 months; HR=3.492, 95% CI:1.239–9.847, P=0.011). No other inflammatory trend correlated with OS. Inflammation dynamics (including CRP) showed no association with best overall response or tumor regression (P>0.05 for all markers). Conclusion: Early reduction in CRP levels during adebrelimab-based chemoimmunotherapy is an potentially predictor of improved survival in ES-SCLC, despite dissociation from initial radiologic response. This suggests that CRP kinetics could serve as a practical, real-world biomarker for prognostication and early efficacy assessment in ES-SCLC. Prospective validation in larger cohorts is essential to confirm these findings.
Keywords: Extensive-stage small cell lung cancer, C-Reactive Protein, Real-world evidence, adebrelimab, PrognosticBiomarker
Received: 20 Sep 2025; Accepted: 28 Oct 2025.
Copyright: © 2025 Wang, Zhang, Gao 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: Jianxin Chen, cjx8137@163.com
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