Immunotherapy maintenance in extensive-stage small-cell lung cancer: a real-world retrospective study.
4 affiliations
- 1Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China.
- 2Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China.
- 3Cancer Center, The Second People's Hospital of Yibin, Sichuan University, Yibin, China.
- 4Yibin Hospital of West China Hospital, Sichuan University, Yibin, China.
Abstract
Although immune checkpoint inhibitors (ICIs) are commonly continued as maintenance therapy after induction for extensive-stage small-cell lung cancer (ES-SCLC), survival remains poor and real-world evidence specifically evaluating post-induction maintenance immunotherapy is limited. This study aimed to evaluate the association between post-induction maintenance immunotherapy and survival outcomes in patients with ES-SCLC treated with first-line chemoimmunotherapy. This multicenter retrospective cohort study included 263 patients with ES-SCLC who received first-line platinum-etoposide chemotherapy plus an ICI. Primary analyses were performed in a landmark cohort of patients alive and progression-free after induction chemoimmunotherapy to reduce immortal-time and guarantee-time bias. Landmark-defined overall survival (OS) and progression-free survival (PFS) were compared between maintenance and non-maintenance groups using Kaplan-Meier analysis and treatment-adjusted Cox models. Inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and an actual/pseudo-index date analysis were performed as sensitivity analyses. The landmark cohort included 235 patients (128 maintenance, 107 non-maintenance). Maintenance immunotherapy was associated with longer landmark-defined OS (median, 370 vs. 243 days; P<0.01) and PFS (median, 209 vs. 124 days; P<0.01). In adjusted Cox models, maintenance remained associated with improved OS [hazard ratio (HR) =0.70; 95% confidence interval (CI): 0.50-0.97] and PFS (HR =0.70; 95% CI: 0.52-0.92). IPTW analyses yielded similar estimates for OS (HR =0.71; 95% CI: 0.51-0.98) and PFS (HR =0.69; 95% CI: 0.52-0.91). PSM analyses were exploratory and showed attenuated, non-significant estimates. In the actual/pseudo-index analysis (174 patients), maintenance remained associated with OS (HR =0.49; 95% CI: 0.30-0.78), whereas the PFS estimate was attenuated and non-significant (HR =0.71; 95% CI: 0.47-1.05; P=0.089). These findings provide hypothesis-generating real-world evidence supporting further prospective evaluation of maintenance immunotherapy as a post-induction strategy in selected patients with ES-SCLC.
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BibTeX
@article{lin2026immunotherapy,
title = {{Immunotherapy maintenance in extensive-stage small-cell lung cancer: a real-world retrospective study.}},
author = {Xiang Lin and Nan Lin and Qian Zhang and Shengxin Zhang and Xiao Liang and Beinuo Wang and Zhenghao Dong and Yu Tong and Yanlin Zhang and Xuelei Ma and Hu Liao},
journal = {Translational cancer research},
year = {2026},
month = sep,
doi = {10.21037/tcr-2026-2409},
url = {https://europepmc.org/article/MED/42997909},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Immunotherapy maintenance in extensive-stage small-cell lung cancer: a real-world retrospective study.
AU - Xiang Lin
AU - Nan Lin
AU - Qian Zhang
AU - Shengxin Zhang
AU - Xiao Liang
AU - Beinuo Wang
AU - Zhenghao Dong
AU - Yu Tong
AU - Yanlin Zhang
AU - Xuelei Ma
AU - Hu Liao
PY - 2026
DA - 2026/09/28
JO - Translational cancer research
DO - 10.21037/tcr-2026-2409
UR - https://europepmc.org/article/MED/42997909
AB - Although immune checkpoint inhibitors (ICIs) are commonly continued as maintenance therapy after induction for extensive-stage small-cell lung cancer (ES-SCLC), survival remains poor and real-world evidence specifically evaluating post-induction maintenance immunotherapy is limited. This study aimed to evaluate the association between post-induction maintenance immunotherapy and survival outcomes in patients with ES-SCLC treated with first-line chemoimmunotherapy. This multicenter retrospective cohort study included 263 patients with ES-SCLC who received first-line platinum-etoposide chemotherapy plus an ICI. Primary analyses were performed in a landmark cohort of patients alive and progression-free after induction chemoimmunotherapy to reduce immortal-time and guarantee-time bias. Landmark-defined overall survival (OS) and progression-free survival (PFS) were compared between maintenance and non-maintenance groups using Kaplan-Meier analysis and treatment-adjusted Cox models. Inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and an actual/pseudo-index date analysis were performed as sensitivity analyses. The landmark cohort included 235 patients (128 maintenance, 107 non-maintenance). Maintenance immunotherapy was associated with longer landmark-defined OS (median, 370 vs. 243 days; P<0.01) and PFS (median, 209 vs. 124 days; P<0.01). In adjusted Cox models, maintenance remained associated with improved OS [hazard ratio (HR) =0.70; 95% confidence interval (CI): 0.50-0.97] and PFS (HR =0.70; 95% CI: 0.52-0.92). IPTW analyses yielded similar estimates for OS (HR =0.71; 95% CI: 0.51-0.98) and PFS (HR =0.69; 95% CI: 0.52-0.91). PSM analyses were exploratory and showed attenuated, non-significant estimates. In the actual/pseudo-index analysis (174 patients), maintenance remained associated with OS (HR =0.49; 95% CI: 0.30-0.78), whereas the PFS estimate was attenuated and non-significant (HR =0.71; 95% CI: 0.47-1.05; P=0.089). These findings provide hypothesis-generating real-world evidence supporting further prospective evaluation of maintenance immunotherapy as a post-induction strategy in selected patients with ES-SCLC.
SN - 2218-676X
SN - 2219-6803
ER -