Resumen de Comparison of the eficacy and safety of anlotinib monotherapy or anlotinib plus immune checkpoint inhibitor for advanced small cell lung cancer with brain metastases

Manyi Xu, Yanhua Wang, Yue Hao, Keda Shao, Zhengbo Song

• Background Anlotinib, as a salvage treatment for patients after failure of third-line or later-line treatments for small cell lung cancer (SCLC), has shown efcacy in patients with brain metastases (BMs). However, the efcacy and safety of anlotinib alone or in combination with immunotherapy for SCLC with BMs remain unclear.

  Method Patients treated with anlotinib alone or in combination with an immune checkpoint inhibitor (ICI) at the Zhejiang Cancer Hospital between April 2019 and February 2023 were identifed. Kaplan–Meier curves were used to describe the progression-free survival (PFS) and intracranial PFS (iPFS). A waterfall diagram was used to indicate changes in intracranial lesions.

  Results A total of 48 patients were included; 29 received anlotinib alone, and 19 were administered anlotinib plus ICI. Combination therapy, compared with anlotinib, was associated with signifcantly longer PFS and iPFS (PFS: 8.1 months vs. 2.5 months, P<0.001; iPFS: 8.1 months vs. 2.5 months, P=0.004). Similar results were observed in patients with multiple BMs (PFS: 8.1 months vs. 1.9 months, P=0.001; iPFS: 8.1 months vs. 1.9 months, P=0.002). After third-line or later-line treatments, patients treated with ICI plus anlotinib also achieved signifcant PFS and iPFS benefts (PFS: 8.4 months vs. 2.1 months, P<0.001; iPFS: 9.2 months vs. 2.1 months, P=0.002). No new or severe adverse events were observed with combination therapy.

  Conclusion The combination of anlotinib and ICI has promising intracranial and extracranial efcacy with tolerable toxicity, and may be a therapeutic option for SCLC patients with BMs.