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797 Real-world treatment duration of atezolizumab+carboplatin+etoposide among older patients with extensive-stage small cell lung cancer (ES-SCLC) and the impact of performance status and brain metastases
  1. Husam Albarmawi1,
  2. Scott Robinson2,
  3. Kevin Dietz2,
  4. Kris Norris2,
  5. Nindhana Paranthaman1,
  6. Sarika Ogale1 and
  7. Taylor Schwartz2
  1. 1Genentech, South San Francisco, CA, USA
  2. 2Inovalon, Bowie, MD, USA


Background Previous real-world studies of first-line (1L) atezolizumab+carboplatin+etoposide for ES-SCLC in the US community oncology setting showed similar treatment durations (medians: 4.9;5.7 months) as in the IMpower133 trial (median: 4.7 months) although the real-world populations had higher proportions of patients with poor ECOG performance status (PS) and brain metastases.1,2 This study measured treatment duration in an older ES-SCLC population initiating 1L atezolizumab+carboplatin+etoposide and the impact of ECOG PS and brain metastases at baseline on treatment duration.

Methods This retrospective cohort study utilized the 100% sample of Medicare Fee-For-Service enrollment and Parts A/B claims from January 1, 2018 to June 30, 2021. Beneficiaries with ≥2 claims with an ICD-10-CM code for lung cancer and claims for atezolizumab+carboplatin+etoposide were identified. Index was 1L treatment initiation occurring between October 11, 2018 to December 31, 2019. ECOG PS at baseline was approximated using a claims-based measure that classifies individuals as good (ECOG 0-1) or fair/poor (ECOG≥2) based on healthcare utilization in the 12-month pre-index period.3 Baseline brain metastases were identified from diagnosis to 30 days post-index based on ICD-10-CM codes. 1L treatment duration was measured from index to a gap in treatment claims of ≥60 days, initiation of a new anti-cancer regimen or death. Kaplan-Meier curves were utilized to examine the differences for patients stratified by brain metastases (Y/N) and binary ECOG PS.

Results A total of 2,470 patients older than 65 years (median age: 73 years) were included in the study with a median follow-up of 8.4 months. 62% had a proxy for fair/poor ECOG PS and 22% had baseline brain metastases. Median 1L duration for the full cohort was 5.4 months (95% CI: 5.2-5.6). Median 1L treatment duration was 5.1 months for patients with poor/fair ECOG PS (95% CI: 5.1-5.3) and 5.8 months (95% CI: 5.6-6.0) for patients with good ECOG PS (figure 1) (Log-Rank p<0.0001). Median 1L treatment duration for patients with brain metastases was 5.0 months (95% CI: 4.6-5.3) and 5.5 months (95% CI: 5.3-5.7) for patients without brain metastases (figure 2) (Log-Rank p=0.2488).

Conclusions Despite the older age of the study population and the worse baseline ECOG PS and brain metastases status, 1L treatment duration with atezolizumab+carboplatin+etoposide was similar to those observed in IMpower133 and in previous real-world community oncology studies. Based on descriptive comparisons, treatment duration was longer in patients with a proxy for good ECOG PS (statistically significant) and patients without brain metastases (not statistically significant).

Acknowledgements Shambhavi Kumar for statistical analysis.


  1. Nadler, Eric S, et al. Real-world evidence of cancer immunotherapy (CIT) combination treatment in first-line (1L) extensive-stage small cell lung cancer (ES-SCLC). 2021;8561–8561.

  2. Tsui DCC, et al. 1650P Adoption and early clinical outcomes of atezolizumab (atezo)+ carboplatin and etoposide (CE) in patients with extensive-stage small cell lung cancer (ES-SCLC) in the real-world (RW) setting. Annals of Oncology. 2021;32:S1164.

  3. Sheffield, Kristin M, et al. Development and validation of a claims-based approach to proxy ECOG performance status across ten tumor groups. Journal of Comparative Effectiveness Research. 2018;7(3):193–208.

Abstract 797 Figure 1

Unadjusted time to the end of 1L treatment for patients with ES-SCLC initiating on carboplatin + etoposide + atezolizumab, by ECOG status (Good vs. Poor/Fair).

Abstract 797 Figure 2

Unadjusted time to the end of 1L treatment for patients with ES-SCLC initiating on carboplatin + etoposide + atezolizumab, by brain metastases at baseline (Yes/No)

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