Real-world comparative effectiveness of atezolizumab versus durvalumab for extensive-stage small-cell lung cancer
Menée au Japon à partir de données en vie réelle portant sur 234 patients atteints d'un cancer du poumon à petites cellules de stade étendu, cette étude de cohorte rétrospective compare l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la toxicité de l'atézolizumab et du durvalumab en traitement de première ligne, puis évalue les coûts associés à ces traitements
Background: Both atezolizumab and durvalumab combined with platinum–etoposide have become standard first-line treatments for extensive-stage small-cell lung cancer (ES-SCLC), yet head-to-head real-world comparative data remain scarce.
Methods: We conducted a multicenter retrospective cohort study of 234 patients with ES-SCLC treated with atezolizumab plus platinum–etoposide (AEP; n = 126) or durvalumab plus platinum–etoposide (DEP; n = 108) across five Japanese institutions between 2016 and 2023. Progression-free survival (PFS) and overall survival (OS) were compared using Kaplan–Meier and overlap-weighted Cox models. Safety, a cost-effectiveness (cost-minimization) analysis based on restricted mean survival time–derived quality-adjusted life years (QALYs), and second-line treatment outcomes were also evaluated.
Results: Median PFS was 5.0 months for AEP and 5.1 months for DEP (hazard ratio [HR] 0.96; 95% CI, 0.73–1.26), and median OS was 12.0 and 12.1 months for AEP and DEP, respectively (HR 0.94; 95% CI, 0.68–1.31). Safety profiles were broadly equivalent between groups. Economic analysis showed nearly identical QALYs (1.002 vs 1.011) but lower total direct medical cost for AEP (¥4.14 million vs ¥4.88 million). Among 128 patients receiving second-line chemotherapy, those with platinum-sensitive relapse had significantly longer OS than those with platinum-refractory relapse, regardless of regimen.
Conclusions: In real-world practice, AEP and DEP demonstrated equivalent efficacy and safety as first-line treatment for ES-SCLC. Given its lower cost with comparable QALYs, AEP may represent the more cost-minimizing option. The prognostic distinction between sensitive and refractory relapse remains clinically relevant after chemoimmunotherapy.
Lung Cancer , résumé, 2026