Association of Immune-Related Adverse Events with Efficacy in Patients With Small Cell Lung Cancer: a Second Analysis of Phase 3 IMpower133 Randomized Clinical Trials

Introduction While immune-related adverse events (irAEs) are associated with improved outcomes for patients with non-small cell lung cancer (NSCLC), this relationship is unelucidated in small cell lung cancer (SCLC), where predictive biomarkers are critically needed.To evaluate the association between irAEs and overall survival (OS) in patients with extensive-stage SCLC (ES-SCLC) receiving first-line chemoimmunotherapy. Methods This secondary analysis utilized individual participant data from the IMpower133 study, a global, phase 3 randomized clinical trial that enrolled patients with previously untreated ES-SCLC receiving atezolizumab plus chemotherapy. Results The development of irAEs was not associated with improved OS. Patients who experienced an irAE had a median OS of 10.0 months compared to 9.77 months for patients without irAEs, a non-significant difference. Conclusions This finding challenges the established paradigm in NSCLC, underscores the distinct immunobiology of SCLC, and cautions against the extrapolation of biomarkers across thoracic malignancies, highlighting the urgent need for disease-specific biomarker discovery.