Keywords
Real-world study (RWS)
Immunotherapy
Chemotherapy
Traditional Chinese medicine (TCM)
Submitted : 2024-10-23
Accepted : 2024-11-07
Published : 2024-11-22
Abstract
Objective: To explore the efficacy of integrated traditional Chinese and Western medicine in the treatment of extensive-stage small cell lung cancer (ES-SCLC). Methods: Patients who were hospitalized and outpatients in the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine from April 1, 2018, to April 1, 2023, were selected and screened according to the inclusion and exclusion criteria. A total of 161 patients were included, of which the control group was chemotherapy combined with traditional Chinese medicine (TCM), and the experimental group was chemotherapy + immunotherapy combined with TCM. The primary endpoint of this study was overall survival (OS), and secondary endpoints included progression-free survival (PFS), objective remission rate (ORR), and disease control rate (DCR). SPSS 25.0 statistical software and R software (version 4.2.1) were used for processing and data analysis. Results: The prognosis of patients treated with chemotherapy + immunotherapy combined with TCM was significantly better than that of the chemotherapy combined with TCM group, with median OS (15.07 months vs. 13.3 months, P = 0.02) and median PFS (6.87 months vs. 5.97 months, P = 0.04). Conclusion: Based on adjuvant therapy with TCM, chemotherapy combined with immunotherapy has more advantages than chemotherapy alone in prolonging the median OS and PFS. It can improve the general condition of patients after treatment, enhance their tolerance, and provide basic guarantees for subsequent treatment.
References
Sung H, Ferlay J, Siegel RL, et al., 2021, Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3): 209–249. https://doi.org/10.3322/caac.21660
Rudin CM, Brambilla E, Faivre-Finn C, et al., 2021, Small-Cell Lung Cancer. Nature Reviews Disease Primers, 7(1): 3. https://doi.org/10.1038/s41572-020-00235-0
Dingemans AC, Früh M, Ardizzoni A, et al., 2021, Small-Cell Lung Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment, and Follow-Up. Annals of Oncology, 32(7): 839–853. https://doi.org/10.1016/j.annonc.2021.03.207
Rossi A, Di Maio M, Chiodini P, et al., 2012, Carboplatin- or Cisplatin-Based Chemotherapy in First-Line Treatment of Small-Cell Lung Cancer: The COCIS Meta-Analysis of Individual Patient Data. Journal of Clinical Oncology, 30(14): 1692–1698. https://doi.org/10.1200/JCO.2011.40.4905
Govindan R, Page N, Morgensztern D, et al., 2006, Changing Epidemiology of Small-Cell Lung Cancer in the United States Over the Last 30 Years: Analysis of the SEER Database. Journal of Clinical Oncology, 24(28): 4539–4544. https://doi.org/10.1200/JCO.2005.04.4859
Jiang J, Liang X, Zhou X, et al., 2010, A Meta-Analysis of Randomized Controlled Trials Comparing Irinotecan/Platinum with Etoposide/Platinum in Patients with Previously Untreated Extensive-Stage Small-Cell Lung Cancer. Journal of Thoracic Oncology, 5(6): 867–73. https://doi.org/10.1097/jto.0b013e3181d95c87
Korde R, Veluswamy R, Allaire JC, et al., 2022, Small Cell Lung Cancer Patients Treated with Immune Checkpoint Inhibitor: A Systematic Literature Review of Treatment Efficacy, Safety, and Quality of Life. Current Medical Research and Opinion, 38(8): 1361–1368. https://doi.org/10.1080/03007995.2022.2078101
Esposito G, Palumbo G, Carillio G, et al., 2020, Immunotherapy in Small Cell Lung Cancer. Cancers, 12(9): 2522. https://doi.org/10.3390/cancers12092522
Cheng Y, Han L, Wu L, et al., 2022, Effect of First-Line Serplulimab vs Placebo Added to Chemotherapy on Survival in Patients with Extensive-Stage Small Cell Lung Cancer: The ASTRUM-005 Randomized Clinical Trial. JAMA, 328(12): 1223–1232. https://doi.org/10.1001/jama.2022.16464
Wang J, Zhou C, Yao W, et al., 2022, Adebrelimab or Placebo Plus Carboplatin and Etoposide as First-Line Treatment for Extensive-Stage Small-Cell Lung Cancer (CAPSTONE-1): A Multicentre, Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial. The Lancet Oncology, 23(6): 739–747. https://doi.org/10.1016/S1470-2045(22)00224-8
Goldman JW, Dvorkin M, Chen Y, et al., 2021, Durvalumab, with or without Tremelimumab, Plus Platinum-Etoposide versus Platinum-Etoposide Alone in First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer (CASPIAN): Updated Results from a Randomised, Controlled, Open-Label, Phase 3 Trial. The Lancet Oncology, 22(1): 51–65. https://doi.org/10.1016/S1470-2045(20)30539-8
Wu S, Sun Z, Guo Z, et al., 2023, The Effectiveness of Blood-Activating and Stasis-Transforming Traditional Chinese Medicines (BAST) in Lung Cancer Progression—A Comprehensive Review. Journal of Ethnopharmacology, 314: 116565. https://doi.org/10.1016/j.jep.2023.116565
He Z, Wang Y, Han L, et al., 2023, The Mechanism and Application of Traditional Chinese Medicine Extracts in the Treatment of Lung Cancer and Other Lung-Related Diseases. Frontiers in Pharmacology, 14: 1330518. https://doi.org/10.3389/fphar.2023.1330518
Pasello G, Pavan A, Attili I, et al., 2020, Real World Data in the Era of Immune Checkpoint Inhibitors (ICIs): Increasing Evidence and Future Applications in Lung Cancer. Cancer Treatment Reviews, 87: 102031. https://doi.org/10.1016/j.ctrv.2020.102031
Wang XQ, Zhang Y, Hou W, et al., 2019, Association Between Chinese Medicine Therapy and Survival Outcomes in Postoperative Patients with NSCLC: A Multicenter, Prospective, Cohort Study. Chinese Journal of Integrative Medicine, 25(11): 812–819. https://doi.org/10.1007/s11655-019-3168-6
Xiao Z, Chen Z, Han R, et al., 2021, Comprehensive TCM Treatments Combined with Chemotherapy for Advanced Non-Small Cell Lung Cancer: A Randomized, Controlled Trial. Medicine, 100(18): e25690. https://doi.org/10.1097/MD.0000000000025690
Li CL, Hsia TC, Yang ST, et al., 2022, Efficacy of Prophylactic Traditional Chinese Medicine on Skin Toxicity of Afatinib in EGFR Mutation-Positive Advanced Lung Adenocarcinoma: A Single-Center, Prospective, Double-Blinded, Randomized-Controlled Pilot Trial. Integrative Cancer Therapies, 21: 15347354221086663. https://doi.org/10.1177/15347354221086663
Di Maio M, Perrone F, Conte P, 2020, Real-World Evidence in Oncology: Opportunities and Limitations. The Oncologist, 25(5): e746–e752. https://doi.org/10.1634/theoncologist.2019-0647
Yu Y, Chen K, Fan Y, 2023, Extensive-Stage Small-Cell Lung Cancer: Current Management and Future Directions. International Journal of Cancer, 152(11): 2243–2256. https://doi.org/10.1002/ijc.34346
Paz-Ares L, Dvorkin M, Chen Y, et al., 2019, Durvalumab Plus Platinum-Etoposide versus Platinum-Etoposide in First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer (CASPIAN): A Randomised, Controlled, Open-Label, Phase 3 Trial. Lancet, 394(10212): 1929–1939. https://doi.org/10.1016/S0140-6736(19)32222-6
Zhang T, Li W, Diwu D, et al., 2023, Efficacy and Safety of First-Line Immunotherapy Plus Chemotherapy in Treating Patients with Extensive-Stage Small Cell Lung Cancer: A Bayesian Network Meta-Analysis. Frontiers in Immunology, 14: 1197044. https://doi.org/10.3389/fimmu.2023.1197044
Falchero L, Guisier F, Darrason M, et al., 2023, Long-Term Effectiveness and Treatment Sequences in Patients with Extensive-Stage Small Cell Lung Cancer Receiving Atezolizumab Plus Chemotherapy: Results of the IFCT-1905 CLINATEZO Real-World Study. Lung Cancer, 185: 107379. https://doi.org/10.1016/j.lungcan.2023.107379
Wang T, Li Y, Zheng X, 2023, Cost-Effectiveness of the Combination of Immunotherapy and Chemotherapy for Extensive-Stage Small-Cell Lung Cancer: A Systematic Review. BMC Health Services Research, 23(1): 691. https://doi.org/10.1186/s12913-023-09727-7
Cai Z, Gu X, Xie J, et al., 2023, Safety and Efficacy of Thoracic Radiotherapy Combined with Chemo-Immunotherapy in Patients with Extensive-Stage Small Cell Lung Cancer: A Multicenter Retrospective Analysis. Translational Lung Cancer Research, 12(10): 1987–2000. https://doi.org/10.21037/tlcr-23-294
Konala VM, Madhira BR, Ashraf S, et al., 2020, Use of Immunotherapy in Extensive-Stage Small Cell Lung Cancer. Oncology, 98(11): 749–754. https://doi.org/10.1159/000508516
Valette CA, Filleron T, Debieuvre D, et al., 2023, Treatment Patterns and Clinical Outcomes of Extensive-Stage Small Cell Lung Cancer (SCLC) in the Real-World Evidence ESME Cohort Before the Era of Immunotherapy. Respiratory Medicine and Research, 84: 101012. https://doi.org/10.1016/j.resmer.2023.101012
Chen Y, Yu M, Liu Z, et al., 2021, Effects of Traditional Chinese Medicine Combined with Chemotherapy for Extensive-Stage Small-Cell Lung Cancer Patients on Improving Oncologic Survival: Study Protocol of a Multicenter, Randomized, Single-Blind, Placebo-Controlled Trial. Trials, 22(1): 437. https://doi.org/10.1186/s13063-021-05407-1
Liu R, He SL, Zhao YC, et al., 2015, Chinese Herbal Decoction Based on Syndrome Differentiation as Maintenance Therapy in Patients with Extensive-Stage Small-Cell Lung Cancer: An Exploratory and Small Prospective Cohort Study. Evidence-Based Complementary and Alternative Medicine, 2015: 601067. https://doi.org/10.1155/2015/601067
Wang M, Jiang H, Zhang M, et al., 2021, “Highly Exposed Chinese Herbal Medicine” Combined with Apatinib as Maintenance Treatment Following First-Line or Second-Line Chemotherapy for Extensive-Stage Small-Cell Lung Cancer: A Single-Arm, Prospective Study. Dose-Response, 19(4): 15593258211055016. https://doi.org/10.1177/15593258211055016
Leem J, 2015, Is Traditional Chinese Herbal Medicine Effective in Prolonging Survival Times in Extensive-Stage Small-Cell Lung Cancer Patients? Integrative Medicine Research, 4(4): 256–9. https://doi.org/10.1016/j.imr.2015.09.004