Feasibility of consolidative immunotherapy and outcomes of chemoradiation for limited-stage small-cell lung cancer in the real world
Abstract
Background Small-cell lung cancer (SCLC) is an aggressive disease presenting with limited stage (LS) in approximately 25% of cases. Objectives This study characterized the routine management of LS-SCLC as a benchmark for the advent of immune checkpoint inhibitors (ICI). Design A retrospective real-world cohort study of 533 consecutive patients with histologically confirmed LS-SCLC treated at the Thoraxklinik between 01/2010-12/2019. Methods Clinical characteristics were extracted from the patients’ records with reassessment of tumor response and progression according to RECIST v1.1 by the investigators. Results Of 533 patients, 418 (78.4%) received curative-intent treatment: definitive chemoradiation (CRT) in 392 patients (73.5%; sequential CRT in 303/392 [77.3%] and concurrent CRT in 89/392 [22.7%]), or surgery followed by adjuvant chemotherapy (n=16, 3.0%) or CRT (n=10, 1.9%). The remaining could receive only single-modality or no therapy with poor median overall survival (mOS) <6 months. Concurrent ( vs. sequential) CRT was associated with longer mOS (28.5 vs. 19.1 months, 34.7% vs. 16.3% at 5 years, p<0.001), which remained significant in multivariable testing (hazard ratio [HR] 0.75, p<0.05). Prophylactic cranial irradiation (PCI) was also associated with longer mOS (23.1 vs. 13.0 months, p<0.001, HR 0.59) and lower risk of intracranial relapse by 61% (p=0.003). The eligibility rate for durvalumab consolidation after concurrent CRT was 87.6% (95% confidence interval 79.0-93.7%), and after any CRT 69.4% (64.6-73.9%), which corresponded to 52.7% (48.3-57.0%) of all LS-SCLC patients. Main ICI contraindication was grade 2+ pneumonitis, which occurred in 10.8% at the end of RT and was more frequent after sequential compared to concurrent treatment (p=0.001). Conclusion Definitive treatment was feasible for approximately 78% of LS-SCLC patients, while approximately 50% are estimated to be eligible for durvalumab post-CRT. Concurrent treatment and administration of PCI were independently associated with better outcomes, but the median OS <2 years in this real-world population underlines the urgent need for novel therapeutic options.
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BibTeX
@article{shi2026feasibility,
title = {{Feasibility of consolidative immunotherapy and outcomes of chemoradiation for limited-stage small-cell lung cancer in the real world}},
author = {Shuo Shi and Teresa Romero Cruz and Florian Stritzke and Romina Maria Rösch and Marlene Luther-Lütkehus and Anna Hofmann and Benedikt Niedermaier and Michael Allgäuer and Farastuk Bozorgmehr and Rajiv Shah and Jonas Kuon and Thomas Held and Fabian Weykamp and Albrecht Stenzinger and Florian Eichhorn and Laura Klotz and Michael Thomas and Gerald Schmid-Bindert and Petros Christopoulos},
journal = {Therapeutic Advances in Medical Oncology},
year = {2026},
month = oct,
doi = {10.1177/17588359261500107},
url = {https://doi.org/10.1177/17588359261500107},
note = {CC BY},
}
RIS
TY - JOUR
TI - Feasibility of consolidative immunotherapy and outcomes of chemoradiation for limited-stage small-cell lung cancer in the real world
AU - Shuo Shi
AU - Teresa Romero Cruz
AU - Florian Stritzke
AU - Romina Maria Rösch
AU - Marlene Luther-Lütkehus
AU - Anna Hofmann
AU - Benedikt Niedermaier
AU - Michael Allgäuer
AU - Farastuk Bozorgmehr
AU - Rajiv Shah
AU - Jonas Kuon
AU - Thomas Held
AU - Fabian Weykamp
AU - Albrecht Stenzinger
AU - Florian Eichhorn
AU - Laura Klotz
AU - Michael Thomas
AU - Gerald Schmid-Bindert
AU - Petros Christopoulos
PY - 2026
DA - 2026/10/24
JO - Therapeutic Advances in Medical Oncology
DO - 10.1177/17588359261500107
UR - https://doi.org/10.1177/17588359261500107
AB - Background Small-cell lung cancer (SCLC) is an aggressive disease presenting with limited stage (LS) in approximately 25% of cases. Objectives This study characterized the routine management of LS-SCLC as a benchmark for the advent of immune checkpoint inhibitors (ICI). Design A retrospective real-world cohort study of 533 consecutive patients with histologically confirmed LS-SCLC treated at the Thoraxklinik between 01/2010-12/2019. Methods Clinical characteristics were extracted from the patients’ records with reassessment of tumor response and progression according to RECIST v1.1 by the investigators. Results Of 533 patients, 418 (78.4%) received curative-intent treatment: definitive chemoradiation (CRT) in 392 patients (73.5%; sequential CRT in 303/392 [77.3%] and concurrent CRT in 89/392 [22.7%]), or surgery followed by adjuvant chemotherapy (n=16, 3.0%) or CRT (n=10, 1.9%). The remaining could receive only single-modality or no therapy with poor median overall survival (mOS) <6 months. Concurrent ( vs. sequential) CRT was associated with longer mOS (28.5 vs. 19.1 months, 34.7% vs. 16.3% at 5 years, p<0.001), which remained significant in multivariable testing (hazard ratio [HR] 0.75, p<0.05). Prophylactic cranial irradiation (PCI) was also associated with longer mOS (23.1 vs. 13.0 months, p<0.001, HR 0.59) and lower risk of intracranial relapse by 61% (p=0.003). The eligibility rate for durvalumab consolidation after concurrent CRT was 87.6% (95% confidence interval 79.0-93.7%), and after any CRT 69.4% (64.6-73.9%), which corresponded to 52.7% (48.3-57.0%) of all LS-SCLC patients. Main ICI contraindication was grade 2+ pneumonitis, which occurred in 10.8% at the end of RT and was more frequent after sequential compared to concurrent treatment (p=0.001). Conclusion Definitive treatment was feasible for approximately 78% of LS-SCLC patients, while approximately 50% are estimated to be eligible for durvalumab post-CRT. Concurrent treatment and administration of PCI were independently associated with better outcomes, but the median OS <2 years in this real-world population underlines the urgent need for novel therapeutic options.
SN - 1758-8359
SN - 1758-8340
ER -