A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy
Progression-free survival (PFS) and overall survival (OS) curves generally approximate first-order kinetics. On log-linear plots, convex curves with downward inflection (indicating late acceleration of progression/death) might arise from stopping effective therapies. We digitized published PFS/OS cu...
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MDPI AG
2025-04-01
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| Series: | Current Oncology |
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| author | David J. Stewart Katherine Cole Stephanie Brule |
| author_facet | David J. Stewart Katherine Cole Stephanie Brule |
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| description | Progression-free survival (PFS) and overall survival (OS) curves generally approximate first-order kinetics. On log-linear plots, convex curves with downward inflection (indicating late acceleration of progression/death) might arise from stopping effective therapies. We digitized published PFS/OS curves for etoposide/platinum-treated extensive small-cell lung cancer (SCLC) and other malignancies and replotted the curves log-linearly. Of 26 SCLC PFS curves, 21 (81%) were highly convex (with a marked late down-turn), and 26 (100%) were moderately or highly convex vs. 35/888 (4%) highly convex and 186 (21%) moderately/highly convex curves for other cancers (<i>p</i> < 0.0001). For SCLC, all 32 OS curves were moderately or highly convex vs. 87/363 (24%) that were moderately/highly convex for other cancers (<i>p</i> < 0.0001). The SCLC PFS curves had an initial downward inflection at a median of 3.1 months (around the completion of first-line chemotherapy), then a second inflection at 5.4 months, with further acceleration of progression. The median PFS half-life was 11.9 months while receiving treatment vs. 1.7 months after the second inflection point. Immunotherapy benefit appeared to be limited to 6–10% of the population. SCLC PFS/OS curves are more often convex than for other cancers, reflecting SCLC chemotherapy sensitivity but rapid progression following the completion of first-line chemotherapy. Effective maintenance strategies are needed. |
| format | Article |
| id | doaj-art-97eae6ea49a1489187eb29282e09e027 |
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| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-97eae6ea49a1489187eb29282e09e0272025-08-20T02:33:31ZengMDPI AGCurrent Oncology1198-00521718-77292025-04-0132525810.3390/curroncol32050258A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance TherapyDavid J. Stewart0Katherine Cole1Stephanie Brule2Faculty of Medicine, Department of Medicine, Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, CanadaFaculty of Medicine, Department of Medicine, Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, CanadaFaculty of Medicine, Department of Medicine, Division of Medical Oncology, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, CanadaProgression-free survival (PFS) and overall survival (OS) curves generally approximate first-order kinetics. On log-linear plots, convex curves with downward inflection (indicating late acceleration of progression/death) might arise from stopping effective therapies. We digitized published PFS/OS curves for etoposide/platinum-treated extensive small-cell lung cancer (SCLC) and other malignancies and replotted the curves log-linearly. Of 26 SCLC PFS curves, 21 (81%) were highly convex (with a marked late down-turn), and 26 (100%) were moderately or highly convex vs. 35/888 (4%) highly convex and 186 (21%) moderately/highly convex curves for other cancers (<i>p</i> < 0.0001). For SCLC, all 32 OS curves were moderately or highly convex vs. 87/363 (24%) that were moderately/highly convex for other cancers (<i>p</i> < 0.0001). The SCLC PFS curves had an initial downward inflection at a median of 3.1 months (around the completion of first-line chemotherapy), then a second inflection at 5.4 months, with further acceleration of progression. The median PFS half-life was 11.9 months while receiving treatment vs. 1.7 months after the second inflection point. Immunotherapy benefit appeared to be limited to 6–10% of the population. SCLC PFS/OS curves are more often convex than for other cancers, reflecting SCLC chemotherapy sensitivity but rapid progression following the completion of first-line chemotherapy. Effective maintenance strategies are needed.https://www.mdpi.com/1718-7729/32/5/258population survival kineticssmall cell lung cancerchemotherapyPD-1/PD-L1 inhibitorsoverall survivalprogression-free survival |
| spellingShingle | David J. Stewart Katherine Cole Stephanie Brule A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy Current Oncology population survival kinetics small cell lung cancer chemotherapy PD-1/PD-L1 inhibitors overall survival progression-free survival |
| title | A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy |
| title_full | A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy |
| title_fullStr | A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy |
| title_full_unstemmed | A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy |
| title_short | A Population Survival Kinetics Assessment of Extensive Small Cell Lung Cancer and Rationale for Maintenance Therapy |
| title_sort | population survival kinetics assessment of extensive small cell lung cancer and rationale for maintenance therapy |
| topic | population survival kinetics small cell lung cancer chemotherapy PD-1/PD-L1 inhibitors overall survival progression-free survival |
| url | https://www.mdpi.com/1718-7729/32/5/258 |
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