Turning the Tide for SCLC: Real World Analysis of Atezolizumab and Platinum-based Chemotherapy in Low-Resource Settings

Abstract Background Small-cell lung cancer (SCLC) represents one of the most aggressive forms of lung malignancies. Due to its aggressive nature, most patients are diagnosed in advanced stage and are candidates for palliative systemic therapy only. While the addition of immunotherapy to standard chemotherapy has shown promise in clinical trials, limited data exists on its real-world effectiveness in Indian populations. We aimed to evaluate outcomes of immunotherapy combined with etoposide-carboplatin chemotherapy in Indian patients with extensive-stage SCLC (ES-SCLC). Methods We conducted a retrospective analysis of 38 patients with ES-SCLC at our center who received atezolizumab plus etoposide-carboplatin, followed by atezolizumab maintenance therapy. Primary endpoints included overall survival (OS) and progression-free survival (PFS). Survival analyses were performed using Kaplan-Meier and Cox proportional hazards models. Results The study population (median age 62.5 years) predominantly comprised male patients (86.8%) with a history of smoking (84.2%). Disease progression occurred in 86.8% of patients. Brain metastases were present in 18.4% of patients at diagnosis, with an additional 39.5% developing intracranial disease during the course of treatment. Median OS (mOS) reached 11.0 months (95% CI: 3.5–18.4), with 12-, 18-, and 24-month survival rates of 42%, 33.6%, and 12.8%, respectively. The median PFS (mPFS) was 4.5 months (95% CI: 3.4–5.6). Multivariate analysis revealed that higher ECOG performance status correlated with inferior survival (HR = 2.22; p < 0.001). Conclusion In this Indian cohort, first-line immunotherapy using Atezolizumab with etoposide-carboplatin demonstrated survival outcomes comparable to international standards. These findings support the integration of immune checkpoint inhibition with standard chemotherapy for ES-SCLC in the Indian healthcare context.