Adebrelimab-based regimens as first-line treatment for ES-SCLC in specific populations: a real-world study in Chinese patients

Background: The efficacy and safety of adebrelimab plus carboplatin and etoposide as first-line therapy in patients with extensive-stage small-cell lung cancer (ES-SCLC) have been investigated in the CAPSTONE-1 study. However, many patients with brain metastases, as well as some with liver metastases and pleural effusion, were excluded. Objectives: The present study focuses on exploring the safety and efficacy of adebrelimab in these patients in the real world. Design: This was a multicenter, prospective, observational, real-world study. Methods: Patients with ES-SCLC and brain metastases, liver metastases, or pleural effusion who were willing to receive adebrelimab-based regimens as first-line therapy were enrolled. The primary endpoint was progression-free survival (PFS). The secondary endpoints included objective response rate, disease control rate, duration of response, overall survival (OS), and safety. Results: Between March 2, 2023, and September 3, 2024, a total of 149 patients were enrolled in the present study. Among them, 50 (33.6%) patients had brain metastasis, 60 (40.3%) had liver metastasis, and 85 (57.0%) had pleural effusion. At data cutoff (May 5, 2025), the median PFS (mPFS) was 6.47 months (95% confidence interval (CI): 5.85–7.03), and the median OS (mOS) was 13.77 months (95%CI: 11.30–15.44) in the full analysis set. Additionally, the mPFS were 6.01 months (95%CI: 4.83–7.59), 5.45 months (95%CI: 4.30–6.51 months), and 6.60 months (95%CI: 5.29–7.59 months) in patients with brain metastases, liver metastases, and pleural effusion, respectively. The mOS were 13.77 months (95%CI: 9.67–22.90 months), 10.51 months (95%CI: 8.38–13.44 months), and 12.85 months (95%CI: 9.20–16.39 months) in patients with brain metastases, liver metastases, and pleural effusion, respectively. Grade ⩾3 treatment-emergent adverse events occurred in 63 (42.3%) patients. No new safety signals were found. Conclusion: Adebrelimab-based regimens showed effectiveness comparable to clinical trials in special populations such as patients with brain metastases or pleural effusion, and demonstrated an acceptable safety profile. However, the benefit appeared limited in patients with liver metastases.