化疗联合免疫治疗（CT-IO）是广泛期小细胞肺癌（ES-SCLC）患者的标准治疗方法。本研究评估了 CT-IO 后二线 (2L) 的有效性。来自 10 个中心的所有在一线 CT-IO 后接受 2L 的患者均被纳入。它们被分为 3 组：铂类药物、lurbinectedin 或其他药物（托泊替康、CAV、紫杉烷）。我们根据治疗和铂类无进展生存期 (PFI) < 或 ≥ 90 天评估了总生存期 (OS) 和 2L 无进展生存期 (2L-PFS)。在纳入的 82 名患者中，中位年龄为 67.0 岁，29.3% 的患者患有Performans Status ≥ 2，36.6% 有脑进展，69.5% 被认为是“铂敏感”，30.5% 被认为是“铂耐药”（PFI ≥ 或 < 90 天，分别）。作为 2L，37/82 名患者 (45.1%) 接受铂类双联治疗，21/82 (25.6%) 接受 lurbinectedin 治疗，24/82 (29.3%) 接受其他治疗。 PFI ≥ 90 天的患者主要接受铂类再挑战（34/57，59.6%）。中位随访时间为 18.5 个月，铂类耐药/敏感的中位 OS 分别为 5.0 个月 (95% CI, 1.5-7.9) / 6.8 个月 (95% CI, 5.5-8.7)（对数等级 p = 0.017）。铂类耐药/敏感的中位 2L-PFS 分别为 1.9 个月（95% CI，1.2-4.7）/3.9 个月（95% CI，2.9-6.0）。铂再挑战/lurbinectedin/其他药物的中位 OS 分别为 8.1 (95%CI, 6.3-12.9) / 4.9 (95%CI, 3.7-6.8) / 5.1 个月 (95%CI, 2.5-7.8) (p = 0.017) 。铂再挑战/lurbinectedin/其他药物的中位 2L-PFS 分别为 4.6 (95%CI, 3.9-7.2) / 2.7 (95%CI, 1.6-3.9) / 2.2 个月 (95%CI, 1.5-4.1) (p = 0.025)。一线 CT-IO 后基于铂的再挑战显示出有希望的结果，尽管在我们的真实人群中存在特别不利的特征。 IO 后使用 Lurbinectedin 的疗效与其他无铂方案一样低。版权所有 © 2024。由 Elsevier B.V. 出版。

Chemotherapy combined with immunotherapy (CT-IO) is the standard treatment for patients with Extensive-Stage Small Cell Lung Cancer (ES-SCLC). This study evaluates the effectiveness of second-line (2L) following CT-IO.All patients from 10 centers who received a 2L after a first-line CT-IO were included. They were divided into 3 groups: platinum-based, lurbinectedin or others (topotecan, CAV, taxanes). We assessed overall survival (OS) and 2L progression-free survival (2L-PFS) according to treatment and platinum free-interval (PFI) < or ≥ 90 days.Among 82 patients included, median age was 67.0 years, 29.3 % had a Performans Status ≥ 2, 36.6 % had brain progression, 69.5 % were considered "platine-sensitive" and 30.5 % "platine-resistant" (PFI ≥ or < 90 days, respectively). As 2L, 37/82 patients (45.1 %) received platinum-doublet, 21/82 (25.6 %) lurbinectedin and 24/82 (29.3 %) others. Patients with a PFI ≥ 90 days received mainly platinum-based rechallenge (34/57, 59.6 %). With a median follow-up of 18.5 months, the median OS was 5.0 months (95 %CI, 1.5-7.9) / 6.8 months (95 %CI, 5.5-8.7) for platinum-resistant / sensitive, respectively (log rank p = 0.017). The median 2L-PFS was 1.9 months (95 %CI, 1.2-4.7) / 3.9 months (95 %CI, 2.9-6.0) for platinum-resistant / sensitive, respectively. Median OS was 8.1 (95 %CI, 6.3-12.9) / 4.9 (95 %CI, 3.7-6.8) / 5.1 months (95 %CI, 2.5-7.8) with platinum rechallenge / lurbinectedin / others, respectively (p = 0.017). Median 2L-PFS was 4.6 (95 %CI, 3.9-7.2) / 2.7 (95 %CI, 1.6-3.9) / 2.2 months (95 %CI, 1.5-4.1) with platinum rechallenge / lurbinectedin / others, respectively (p = 0.025).Platinum-based rechallenge after a first-line CT-IO showed promising results despite particularly unfavorable characteristics within our real-word population. Lurbinectedin when used after IO demonstrated as low efficacy as other platinum-free regimens.Copyright © 2024. Published by Elsevier B.V.