Real-world effectiveness and safety of adebrelimab as first-line treatment in patients with extensive-stage small cell lung cancer

Introduction

Small-cell lung cancer (SCLC) is a highly aggressive malignancy that accounts for approximately 15% of all lung cancer cases. It is strongly associated with tobacco use and is characterized by rapid progression and early metastasis (1-3). At initial diagnosis, only about 30% of patients present with limited-stage disease, while the remaining 70% have extensive-stage SCLC (ES-SCLC), which is associated with a poor prognosis and limited treatment options. In the past, platinum-based chemotherapy has been the standard first-line treatment for ES-SCLC (4); however, the clinical benefit has been limited. Most patients experience disease recurrence within six months of treatment initiation. The median overall survival (OS) is approximately 10 months (5,6). The emergence of immunotherapy has introduced new therapeutic options for the management of ES-SCLC.

Several phase III clinical trials have demonstrated the benefits of combining immunotherapy with chemotherapy in ES-SCLC. Notably, the IMpower133 study demonstrated that the addition of atezolizumab to chemotherapy significantly improved both OS and progression-free survival (PFS), with a median OS (mOS) of 12.3 months compared to 10.3 months with chemotherapy alone [hazard ratio (HR) 0.76; 95% confidence interval (CI): 0.60–0.95] (7). The CASPIAN trial revealed that durvalumab with chemotherapy extended mOS to 12.9 months compared to chemotherapy alone (8). Additionally, the ASTRUM-005 trial reported an mOS of 15.4 months for serplulimab plus chemotherapy, significantly longer than 10.9 months with placebo (HR 0.63; 95% CI: 0.49–0.82) (9). Similarly, the RATIONALE-312 and EXTENTORCH trials confirmed the survival benefits of adding tislelizumab and toripalimab to platinum-etoposide regimens, with mOS of 15.5 and 14.6 months, respectively (10,11).

Adebrelimab is a humanized immunoglobulin G4 (IgG4) monoclonal antibody targeting programmed death-ligand 1 (PD-L1), which has shown promising results in combination with chemotherapy for the first-line treatment of ES-SCLC. In the CAPSTONE-1 trial, adding adebrelimab to carboplatin and etoposide significantly extended mOS to 15.3 months (HR 0.72; 95% CI: 0.58–0.90), with 2- and 3-year OS rates of 31.3% and 27.8%, respectively, and acceptable safety (12). While randomized controlled trials (RCTs) offer high-quality evidence, their strict inclusion criteria limit real-world applicability. Real-world data (RWD) are essential to evaluate the effectiveness and safety of new therapies in broader patient populations encountered in routine practice.

The present study aims to assess the real-world effectiveness and safety of adebrelimab in patients with ES-SCLC, thereby providing insights into its clinical utility beyond controlled trial settings. We present this article in accordance with the STROBE reporting checklist (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-aw-1263/rc).

Methods

Study design

This study is a multicenter, prospective real-world analysis based on data extracted from a lung cancer-specific registry database collected between February 2023 and July 2024 at the Eastern Theater Command General Hospital and 38 affiliated centers (Table S1). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the Eastern Theater Command General Hospital (No. 2022DZKY-042-01). All participating hospitals were informed and agreed to the study. Written informed consent was obtained from all patients prior to treatment.

Patients

Key inclusion criteria were as follows: patients aged ≥18 years; histologically or cytologically confirmed, unresectable SCLC; only patients with pure SCLC were included in the analysis; at least one measurable lesion as defined by Response Evaluation Criteria in Solid Tumors (RECIST, version 1.1); an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–2; an estimated life expectancy of ≥12 weeks; and adequate organ and bone marrow function. Patients with previously treated, asymptomatic central nervous system (CNS) metastases were allowed for inclusion. Patients with a history of limited-stage SCLC (LS-SCLC) were eligible if they had received definitive therapy, and there was a treatment-free interval of at least 6 months between the last administration of chemotherapy, radiotherapy, or chemoradiotherapy and the diagnosis of ES-SCLC.

Key exclusion criteria included the presence of active or untreated CNS metastases; active or a history of autoimmune diseases or interstitial lung disease; and the administration of immunosuppressive agents within 14 days prior to the first dose of adebrelimab; however, corticosteroids were allowed during the treatment period if clinically indicated, such as for the management of immune-related adverse events (irAEs).

Intervention

Following enrollment, investigators determined the appropriate adebrelimab-based treatment regimen based on individual patient condition and clinical assessments. In reference to the registration trial of adebrelimab, the recommended dosage was 20 mg/kg administered via intravenous infusion every 21 days, with a dosing window of ±3 days. Chemotherapy backbones were selected in accordance with current clinical guidelines, with most patients receiving etoposide plus a platinum agent (typically carboplatin or cisplatin). Alternative regimens were used in a minority of patients based on individual clinical circumstances, physician judgment, and patient preference. Treatment continued until disease progression, death, or the occurrence of unacceptable toxicity.

Effectiveness assessment and safety

The primary outcome of this study was PFS. Secondary outcomes included objective response rate (ORR), disease control rate (DCR), and OS. Laboratory and imaging assessments were performed every 12 weeks (±7 days) following the first dose. No predefined statistical hypothesis or threshold was set for these outcomes. Tumor response was evaluated according to RECIST version 1.1 criteria. Physical examinations and vital sign measurements were conducted within 72 hours prior to each treatment cycle, as well as whenever patients developed new or worsening respiratory symptoms. The severity of adverse events (AEs) was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Statistical analysis

As this study was observational and not designed to test formal statistical hypotheses, no sample size calculation was performed. OS, PFS, and duration of response were estimated using the Kaplan-Meier method, with 95% CIs calculated using the Brookmeyer-Crowley method. Pre-specified subgroup analyses for OS and PFS were performed using an unstratified Cox proportional hazards model based on age, sex, ECOG PS, smoking history, LDH, and the presence of brain or liver metastases. ORR and DCR were assessed by investigators according to RECIST version 1.1 in the full analysis set, with 95% CIs estimated using the Clopper-Pearson method. Categorical variables were summarized as counts and percentages and compared using the chi-square test or Fisher’s exact test, as appropriate. The distribution of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed data are presented as mean ± standard deviation (SD), while non-normally distributed data are shown as median with interquartile range (IQR). All statistical analyses were performed using R software (version 4.2.3) and MedCalc (version 18.2.1).

Results

Patients

A total of 170 patients with ES-SCLC were included in the study. The median age was 69 years (IQR, 62–73 years); none had received prior systemic therapy beyond first-line. The majority of patients were male (81.76%, n=139), and 18.24% (n=31) were female. ECOG PS was 0 in 11.18% (n=19), 1 in 87.65% (n=149), and 2 in 1.18% (n=2) of patients. Although the inclusion criteria specified ECOG PS 0–1, two patients with PS 2 were included based on clinical judgment. Both patients were deemed suitable for immunotherapy by their treating physicians due to strong treatment motivation and adequate general health. Most patients (97.06%, n=165) had stage IV disease, and 2.94% (n=5) had stage III disease. The most common metastatic sites included the liver (21.17%, n=36) and brain (16.47%, n=28). In addition to liver and brain metastases, other metastatic sites included lymph nodes (88.82%), bone (16.47%), pleura (16.47%), and adrenal glands (5.29%). Elevated lactate dehydrogenase (LDH) levels above the upper limit of normal (ULN) were observed in 17.06% (n=29), while 82.35% (n=140) had normal LDH levels; data were not available for one patient. Regarding smoking history, 43.53% (n=74) were current or former smokers, 54.71% (n=93) had no history of smoking, and status was unknown for three patients (1.76%). Hypertension was reported in 33.53% (n=57), while 65.88% (n=112) had no history of hypertension; one case (0.59%) was unknown. Type 2 diabetes mellitus (T2DM) was present in 14.12% (n=24) of patients, absent in 85.29% (n=145), with one case (0.59%) unknown (Table 1).

All 170 patients received adebrelimab-based first-line treatment for ES-SCLC. Among them, 161 patients (94.71%) received adebrelimab in combination with chemotherapy. The most frequently used regimen was adebrelimab plus etoposide and platinum (carboplatin, cisplatin, lobaplatin, or nedaplatin) in 132 patients (77.65%). Other regimens included adebrelimab plus chemotherapy followed by thoracic radiotherapy (n=9) or anti-angiogenic therapy (n=8), adebrelimab plus irinotecan with or without cisplatin (n=3), adebrelimab plus etoposide monotherapy (n=2), adebrelimab plus nab-paclitaxel with or without other agents (n=5), and adebrelimab combined with other regimens (n=3). A smaller proportion received adebrelimab alone (n=6, 3.53%) or adebrelimab combined with anti-angiogenic therapy (n=3, 1.76%). The median duration of adebrelimab treatment was 5.72 months (95% CI: 2.85–8.90). The median number of adebrelimab treatment cycles was 7 (IQR, 4–10) (Table 2).

Tumor response and survival outcomes

At the data cutoff in December 2024, the median follow-up time was 9.66 months (95% CI: 8.80–10.64), and 2 patients (1.18%) were lost to follow-up. Among the 170 enrolled patients, the ORR was 69.4% (95% CI: 62.5–76.3%), including 1 patient (0.6%) achieving complete response (CR) and 117 patients (68.8%) achieving partial response (PR), resulting in a DCR of 89.4% (95% CI: 83.9–93.2%) (Table 3). The mOS was 14.29 months (95% CI: 11.89–17.12) (Figure 1A), while the median PFS (mPFS) was 7.03 months (95% CI: 6.08–8.05) (Figure 1B). Among the 118 patients who achieved an objective response, the median DOR (mDOR) was 5.59 months (95% CI: 4.44–8.02) (Figure 1C). Notably, the two patients with ECOG PS 2 demonstrated good treatment tolerance without unexpected AEs.

Figure 1 Kaplan-Meier survival analyses of patients with ES-SCLC treated with adebrelimab-based therapy: (A) OS; (B) PFS; (C) DoR. CI, confidence interval; DoR, duration of response; ES-SCLC, extensive-stage small cell lung cancer; mDoR, median duration of response; mOS, median overall survival; mPFS, median progression-free survival; OS, overall survival; PFS, progression-free survival.

Safety

Among the 170 patients included in the safety analysis, 96.5% (n=164) experienced at least one AE, and 19.4% (n=33) experienced grade ≥3 AEs. Hematological AEs were the most frequently reported, occurring in 91.2% (n=155) of patients, with 18.2% (n=31) experiencing grade ≥3 events. Non-hematological AEs occurred in 70.6% (n=120) of patients, but only 1.8% (n=3) were grade ≥3. The most common AEs of any grade included anemia (67.7%), hypoalbuminemia (48.2%), decreased lymphocyte count (40.0%), decreased white blood cell count (31.2%), nausea (26.5%), asthenia (25.3%), and decreased neutrophil count (19.4%). Among grade ≥3 AEs, the most frequent were neutropenia (8.2%), lymphopenia (5.3%), and anemia (4.1%) (Table 4).

Prognostic factor analyses

Univariate Cox regression identified several factors significantly associated with PFS, including liver metastasis (HR 1.780; 95% CI: 1.159–2.734; P=0.008), elevated LDH levels (HR 2.118; 95% CI: 1.298–3.455; P=0.003), hypertension (HR 1.545; 95% CI: 1.039–2.296; P=0.03), and grade ≥3 AEs (HR 1.643; 95% CI: 1.069–2.524; P=0.02). In multivariate analysis, liver metastasis (HR 1.852; 95% CI: 1.198–2.862; P=0.006), elevated LDH (HR 1.704; 95% CI: 1.011–2.875; P=0.046), hypertension (HR 1.578; 95% CI: 1.058–2.353; P=0.03), and grade ≥3 AEs (HR 1.590; 95% CI: 1.000–2.527; P=0.050) remained independently associated with inferior PFS (Table S2). Regarding OS, univariate analysis showed that age ≥70 years (HR 1.776; 95% CI: 1.151–2.741; P=0.009), liver metastasis (HR 2.045; 95% CI: 1.284–3.257; P=0.003), and grade ≥3 AEs (HR 1.650; 95% CI: 1.021–2.668; P=0.041) were significant risk factors. In multivariate analysis, age ≥70 years (HR 1.656; 95% CI: 1.064–2.578; P=0.03) and liver metastasis (HR 2.025; 95% CI: 1.270–3.231; P=0.003) were independently associated with shorter OS. Grade ≥3 AEs showed a non-significant trend toward worse OS (HR 1.538; 95% CI: 0.944–2.507; P=0.08) (Table S3).

Discussion

Previous studies have demonstrated the efficacy and safety of programmed cell death 1 (PD-1)/PD-L1 inhibitors in ES-SCLC in clinical trials, however the effectiveness of these immune checkpoint inhibitors (ICIs) in the real world remains unknown. In this real-world analysis of 170 ES-SCLC patients treated with adebrelimab-based regimens, we observed a mOS of 14.29 months and mPFS of 7.03 months, with an mDOR of 5.59 months.

This real-world, multicenter study demonstrated that adebrelimab-based first-line treatment in patients with ES-SCLC achieved a mPFS of 7.03 months and a mOS of 14.29 months, with an ORR of 69.41% and a DCR of 89.41%. Multiple phase III trials have established the survival benefits of incorporating immunotherapy into first-line chemotherapy. The IMpower133 trial with atezolizumab reported an mOS of 13.9 months and mPFS of 5.2 months, and the CASPIAN trial with durvalumab demonstrated an mOS of 13.0 months and mPFS of 5.3 months (7,8). Notably, the CAPSTONE-1 trial of adebrelimab in a randomized setting reported an mOS of 15.3 months and an mPFS of 5.8 months (12). Similarly, the ASTRUM-005 trial of serplulimab achieved an mOS of 15.8 months and mPFS of 5.8 months (9). The EXTENTORCH and RATIONALE-312 studies with toripalimab and tislelizumab, respectively, reported comparable OS ranging from 14.6 to 15.5 months, and PFS between 4.8 and 5.8 months (10,11). Our results were consistent with these pivotal phase III trials, suggesting adebrelimab retains reliable clinical activity outside the confines of controlled clinical trials. Importantly, unlike the strict eligibility criteria in phase III trials, this real-world study included patients with ECOG PS 2 as well as those with active hepatitis B virus (HBV) infection—populations typically excluded from RCTs. The observed survival outcomes in our cohort suggest that adebrelimab-based therapy remains effective in a broader, more heterogeneous population, thereby underscoring its generalizability and real-world applicability in routine clinical practice.

In our real-world cohort, the vast majority of patients (77.65%; 132/170) received etoposide in combination with a platinum agent—most commonly carboplatin or cisplatin, with minority use of lobaplatin or nedaplatin—consistent with standard clinical practice for ES-SCLC. A small subset received irinotecan-based regimens (n=3), while etoposide monotherapy (n=2), nab-paclitaxel (± additional agents; n=5), and other regimens (n=1) were far less common. Although the use of non-standard regimens introduces some heterogeneity, their low frequency minimizes potential bias in outcome interpretation. Importantly, the choice of chemotherapy backbone in this observational setting was influenced by clinical factors such as comorbidities, toxicity concerns, physician judgment, and patient preference. This variability reflects the inherent flexibility of real-world clinical practice. Despite the heterogeneity, the overall robust effectiveness of adebrelimab across different regimens supports the generalizability of our findings to broader patient populations.

In our real-world study, adebrelimab-based therapy demonstrated an acceptable safety profile, with no new or unexpected AEs reported. Grade ≥3 treatment-related AEs occurred in 19.4% of patients, with neutropenia, leukopenia, and thrombocytopenia being the most common. This incidence is lower than that observed in several phase III trials of other PD-1/PD-L1 inhibitors in ES-SCLC. For example, grade ≥3 AEs leading to treatment discontinuation occurred in 13.2% of patients in the RATIONALE-312 trial (tislelizumab), 14.0% in EXTENTORCH (toripalimab), and 7.7% in ASTRUM-005 (serplulimab) (9-11). In contrast, our study reported a lower AE-related discontinuation rate of 4.1%. irAEs were observed in 27.8% of patients in the CAPSTONE-1 trial, 38.3% in RATIONALE-312, and 42.7% in ETER70. In the present study, AEs were recorded in a prospective lung cancer database that includes multiple treatment modalities. Therefore, AEs were systematically collected as treatment-related adverse events (TRAEs), and irAEs were not separately categorized. Compared to these trials, the overall incidence of severe AEs in our cohort remained manageable. Importantly, no treatment-related deaths occurred, further supporting the favorable safety profile of adebrelimab in routine clinical practice. These findings indicate that adebrelimab retains a manageable toxicity profile in a broader real-world population and is consistent with or superior to that observed in controlled clinical trials settings.

Our Cox regression analysis demonstrated that liver metastasis and elevated LDH were independently associated with shorter PFS (liver metastasis HR =1.85, P=0.006; LDH HR =1.70, P=0.046). For OS, liver metastasis (HR =2.05, P=0.003) also retained independent prognostic significance. A recent meta-analysis of 16 RCTs and 14 observational studies reported that liver metastases increase mortality risk by 21% in lung cancer patients receiving ICIs (OS HR 1.21; 95% CI: 1.17–1.27) (13). Furthermore, in a retrospective analysis of ES-SCLC patients treated with chemo-immunotherapy, liver metastasis independently predicted both PFS and OS (14). A meta-analysis of 4,785 SCLC patients demonstrated that high serum LDH correlates with significantly shorter OS (HR 1.45) (15) and retrospective analyses further defined elevated LDH as an independent prognostic biomarker in ES-SCLC (16-18). Mechanistically, increased LDH reflects higher tumor burden, enhanced glycolysis, and hypoxic tumor microenvironments, which impair T-cell-mediated immunity and reduce ICI efficacy (19). Similarly, liver metastasis has been associated with poor prognosis in ES-SCLC, potentially due to the liver’s unique immunosuppressive microenvironment. The liver promotes systemic immune tolerance through immunomodulatory cells such as Kupffer cells and liver sinusoidal endothelial cells, which induce regulatory T cells and secrete immunosuppressive cytokines (20,21). This immunotolerant milieu impairs systemic anti-tumor immune responses and reduces the efficacy of ICIs. These results underscore the validity of LDH and liver metastasis as clinically meaningful biomarkers for risk stratification in SCLC.

The relatively high proportion of never-smokers observed in our cohort (54.71%) is notably higher than typically reported in ES-SCLC populations. This discrepancy may be influenced by regional and demographic factors, as the data for this study were obtained from a prospective lung cancer registry based in Jiangsu Province, China. Differences in smoking prevalence, healthcare-seeking behaviors, and referral patterns in specific geographic regions may contribute to the observed distribution. Moreover, cultural and environmental exposures unrelated to tobacco may also play a role in the pathogenesis of SCLC in non-smoking populations. While this finding reflects real-world characteristics within a defined setting, it may limit the generalizability of our results to broader global SCLC populations, particularly in regions with higher smoking rates. Future studies in more diverse populations are warranted to validate our findings.

There are several limitations in this study. First, our sample size is modest, which may limit the statistical power and generalizability. Second, without a comparator arm using an alternative PD-1/PD-L1 inhibitor, definitive conclusions regarding the relative efficacy of adebrelimab are constrained.

Conclusions

In conclusion, adebrelimab-based therapy demonstrated favorable real-world effectiveness and manageable safety in ES-SCLC, supporting its clinical utility beyond controlled trial settings. These findings reinforce adebrelimab as a viable first-line option.

Acknowledgments

We would like to thank all the participants who made the study possible.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-aw-1263/rc

Data Sharing Statement: Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-aw-1263/dss

Peer Review File: Available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-aw-1263/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-2025-aw-1263/coif). Yong Song serves as an Editor-in-Chief of Translational Lung Cancer Research. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the Eastern Theater Command General Hospital (No. 2022DZKY-042-01). All participating hospitals were informed and agreed to the study. Written informed consent was obtained from all patients prior to treatment.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Rudin CM, Brambilla E, Faivre-Finn C, et al. Small-cell lung cancer. Nat Rev Dis Primers 2021;7:3. [Crossref] [PubMed]
2. Sen T, Takahashi N, Chakraborty S, et al. Emerging advances in defining the molecular and therapeutic landscape of small-cell lung cancer. Nat Rev Clin Oncol 2024;21:610-27. [Crossref] [PubMed]
3. Oronsky B, Abrouk N, Caroen S, et al. A 2022 Update on Extensive Stage Small-Cell Lung Cancer (SCLC). J Cancer 2022;13:2945-53. [Crossref] [PubMed]
4. Farago AF, Keane FK. Current standards for clinical management of small cell lung cancer. Transl Lung Cancer Res 2018;7:69-79. [Crossref] [PubMed]
5. Rossi A, Di Maio M, Chiodini P, et al. Carboplatin- or cisplatin-based chemotherapy in first-line treatment of small-cell lung cancer: the COCIS meta-analysis of individual patient data. J Clin Oncol 2012;30:1692-8. [Crossref] [PubMed]
6. Sathiyapalan A, Febbraro M, Pond GR, et al. Chemo-Immunotherapy in First Line Extensive Stage Small Cell Lung Cancer (ES-SCLC): A Systematic Review and Meta-Analysis. Curr Oncol 2022;29:9046-65. [Crossref] [PubMed]
7. Horn L, Mansfield AS, Szczęsna A, et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med 2018;379:2220-9. [Crossref] [PubMed]
8. Paz-Ares L, Dvorkin M, Chen Y, et al. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet 2019;394:1929-39. [Crossref] [PubMed]
9. Cheng Y, Han L, Wu L, et al. Effect of First-Line Serplulimab vs Placebo Added to Chemotherapy on Survival in Patients With Extensive-Stage Small Cell Lung Cancer: The ASTRUM-005 Randomized Clinical Trial. JAMA 2022;328:1223-32. [Crossref] [PubMed]
10. Cheng Y, Fan Y, Zhao Y, et al. Tislelizumab Plus Platinum and Etoposide Versus Placebo Plus Platinum and Etoposide as First-Line Treatment for Extensive-Stage SCLC (RATIONALE-312): A Multicenter, Double-Blind, Placebo-Controlled, Randomized, Phase 3 Clinical Trial. J Thorac Oncol 2024;19:1073-85. [Crossref] [PubMed]
11. Cheng Y, Zhang W, Wu L, et al. Toripalimab Plus Chemotherapy as a First-Line Therapy for Extensive-Stage Small Cell Lung Cancer: The Phase 3 EXTENTORCH Randomized Clinical Trial. JAMA Oncol 2025;11:16-25. [Crossref] [PubMed]
12. Wang J, Zhou C, Yao W, et al. Adebrelimab or placebo plus carboplatin and etoposide as first-line treatment for extensive-stage small-cell lung cancer (CAPSTONE-1): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022;23:739-47. [Crossref] [PubMed]
13. Xia H, Zhang W, Zhang Y, et al. Liver metastases and the efficacy of immune checkpoint inhibitors in advanced lung cancer: A systematic review and meta-analysis. Front Oncol 2022;12:978069. [Crossref] [PubMed]
14. Kaira K, Kurata Y, Imai H, et al. Prognostic factors of liver metastases in extensive-stage small cell lung cancer receiving chemo-immunotherapy. Transl Lung Cancer Res 2025;14:1569-81. [Crossref] [PubMed]
15. Lim JU, Kang HS, Shin AY, et al. Investigation of poor predictive factors in extensive stage small cell lung cancer under etoposide-platinum-atezolizumab treatment. Thorac Cancer 2022;13:3384-92. [Crossref] [PubMed]
16. He M, Chi X, Shi X, et al. Value of pretreatment serum lactate dehydrogenase as a prognostic and predictive factor for small-cell lung cancer patients treated with first-line platinum-containing chemotherapy. Thorac Cancer 2021;12:3101-9. [Crossref] [PubMed]
17. Chen C, Zhu YH, Huang JA. Clinical evaluation of potential usefulness of serum lactate dehydrogenase level in follow-up of small cell lung cancer. J Cancer Res Ther 2018;14:S336-40. [Crossref] [PubMed]
18. Huang W, Liu P, Zong M, et al. Combining Lactate Dehydrogenase and Fibrinogen: Potential Factors to Predict Therapeutic Efficacy and Prognosis of Patients with Small-Cell Lung Cancer. Cancer Manag Res 2021;13:4299-307. [Crossref] [PubMed]
19. Van Wilpe S, Koornstra R, Den Brok M, et al. Lactate dehydrogenase: a marker of diminished antitumor immunity. Oncoimmunology 2020;9:1731942. [Crossref] [PubMed]
20. Lee JC, Mehdizadeh S, Smith J, et al. Regulatory T cell control of systemic immunity and immunotherapy response in liver metastasis. Sci Immunol 2020;5:eaba0759. [Crossref] [PubMed]
21. Zhang XC, Zhou YW, Wei GX, et al. Locoregional therapies combined with immune checkpoint inhibitors for liver metastases. Cancer Cell Int 2024;24:302. [Crossref] [PubMed]