A real-world analysis of 30-day post systemic anti-cancer therapy mortality in patients with small cell lung cancer

Abstract

Introduction: Small cell lung cancer (SCLC) is highly aggressive with a poor prognosis. Chemo-immunotherapy is recommended as first-line treatment in patients of good performance status and has excellent response rates. However, patients frequently present late or with oncological emergencies such as superior vena cava obstruction (SVCO) where benefits of systemic anti-cancer therapy (SACT) are less clear. This study aimed to evaluate SCLC patients who died within 30 days of SACT administration to better understand this at-risk patient group. Methods: Patients with SCLC who died within 30 days of receiving SACT between August 2012 and September 2019 at the Christie Hospital, UK, were characterised for demographics, oncological history, clinical features and cause of death. A comparator cohort of patients who did not die within 30 days was randomly generated from health records and analysed for statistical differences and multivariate post-SACT survival. Results: There were 105 SCLC patients who died within 30 days of SACT. The majority were elderly and 81% were performance status 2 or 3 (Table 1). SVCO was present in 25%, 82% of patients were receiving first-line SACT, 42% received single-agent carboplatin and 38% died within ten days of SACT. Cause of death was determined to be progressive disease in 63% and neutropenic sepsis in 9.5%, with 28.6% possibly related to SACT. Comparison with 95 comparator patients showed significantly higher SVCO (p=0.01) and performance status (p<0.001) in the 30-day mortality cohort. Higher performance status, raised leukocytes and low serum sodium were associated with lower 30-day post-SACT survival on multivariate analysis (hazard ratio 1.77, 1.08, 0.96 respectively). Conclusions: International guidelines support combination SACT in SCLC patients of good performance status, but nuances remain regarding optimal SACT for frailer patients. These results highlight the high risk of 30-day post-SACT mortality in SCLC, particularly in those with markers of poor prognosis.