Navigating first-line therapies for extensive-stage small-cell lung cancer: a frequentist network meta-analysis and systematic review

Aim: To identify the optimal first-line treatment for patients with extensive-stage small-cell lung cancer (ES-SCLC).
Materials & methods: We conducted a network meta-analysis (CRD42023486863) to systematically evaluate the efficacy and safety of eight first-line treatment regimens for ES-SCLC, including 15 clinical trials.
Results: Our analysis showed that the PD-1/PD-L1 + etoposide combined with platinum (EP) and PD-L1 + vascular endothelial growth factor (VEGF) + EP regimens significantly enhanced overall survival and progression-free survival, with subgroup analysis revealing that serplulimab ranked as the most promising option for improving overall survival. Integrating anti-angiogenesis drugs into immunochemotherapy presents potential benefits, with an increased incidence of adverse events necessitating further investigation.
Conclusion: Our findings offer valuable insights for future research and for developing more effective treatment strategies for ES-SCLC, underscoring the critical need for continued innovation in this therapeutic area.
Immunochemotherapy has changed the treatment landscape of extensive-stage small-cell lung cancer (ES-SCLC), but the efficacy of this strategy still needs improvement.
Compared with chemotherapy, immunochemotherapy has demonstrated a significantly enhanced overall survival (OS) and progression-free survival in patients with ES-SCLC. Furthermore, integrating anti-angiogenesis drugs into immunochemotherapy regimens has shown an additional benefit.
The efficacy and safety of PD-1 inhibitors and PD-L1 inhibitors have no significant difference.
Serplulimab ranked as the most promising option combined with chemotherapy for improving the OS of ES-SCLC patients.
Combining anti-angiogenesis targeted therapy with immunochemotherapy presents a promising direction for future studies, which need further exploration.
Notably, combining anti-angiogenesis targeted therapy with immunochemotherapy was associated with increased grade ≥3 TRAEs.
Our study indicated multidisciplinary treatment strategies that could potentially transform the therapeutic landscape for ES-SCLC, underscoring the need for continued innovation and research in this field.
The findings have significant implications for clinical decision-making, potentially guiding the development of more effective treatment strategies for this highly challenging form of lung cancer.