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There is currently no available predictive biomarker to identify which patients would benefit most from this treatment. We hypothesized that pre-treatment PD-L1 expression on circulating immune cells might predict survival outcomes and toxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>\n                      This prospective, multi-center observational study included patients with untreated ES-SCLC treated with first-line durvalumab plus platinum-based chemotherapy. The percentages of circulating PD-L1\n                      <jats:sup>+<\/jats:sup>\n                      immune cells at baseline were analysed by flow cytometry to assess their association with survival outcomes and the development of immune-related adverse events (irAEs).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 41 patients with ES-SCLC, 65.9% were male, 73.2% had an ECOG-PS 1, 9.8% had central nervous system (CNS) metastases and 31.7% had liver metastases. Sixteen patients (39%) experienced irAEs. Median PFS was longer in patients with high percentages of circulating PD-L1\n                      <jats:sup>+<\/jats:sup>\n                      monocytes compared to those with low percentages: 8.97 months (95% CI NR to NR) vs. 5.97 months (95% CI 4.65 to 7.28),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007. There was a trend toward longer median OS in patients with ES-SCLC and high percentages of circulating PD-L1\n                      <jats:sup>+<\/jats:sup>\n                      monocytes versus low percentages: NR (95% CI NR-NR) vs. 9.13 months (95% CI 6.34 to 11.92),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.092. Patients with higher circulating PD-L1\n                      <jats:sup>+<\/jats:sup>\n                      neutrophils correlated with the development of irAES (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our results showed a statistically significant longer PFS in patients with ES-SCLC and high percentages of circulating PD-L1\n                      <jats:sup>+<\/jats:sup>\n                      monocytes. This suggests PD-L1 expression on monocytes might be established as a predictive biomarker for patients with ES-SCLC treated with upfront chemo-immunotherapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      NCT04712903 Trial. Last registered 1 December 2025,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.clinicaltrials.gov\/study\/NCT04712903\" ext-link-type=\"uri\">https:\/\/www.clinicaltrials.gov\/study\/NCT04712903<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12967-026-07896-7","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T12:04:50Z","timestamp":1772280290000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Baseline PD-L1 expression on circulating immune cells as a predictor of survival and immune-related adverse events in extensive-stage small-cell lung cancer patients treated with durvalumab and carboplatin-etoposide (NCT04712903 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Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants were made aware what kind of personal data will be processed, how it will be used and for what purpose. The authors affirm that human research participants provided informed consent for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The following authors declare potential conflicts of interest outside the submitted work: Serra J: Astellas, Invited Speaker, Personal Astra Zeneca, Invited Speaker, Personal Astra Zeneca, Advisory Board, Personal BMS, Invited Speaker, Personal MSD, Invited Speaker, Personal MSD, Advisory Board, Personal Roche, Invited Speaker, Personal Eisai, Invited Speaker, Personal La Roche Posay, invited Speaker, Personal Johnson and Johnson, Invited Speaker, Personal Barba A: Astrazeneca advisory board and invited speaker, BMS expert testimony and invited speaker, Jansenn congress funding, MSD invited speaker, Novartis invited speaker, Pfizer invited speaker and congress funding, Piere Fabre invited speaker and congress funding, Regeneron invited speaker, Roche invited speaker and advisory board, Sanofy advisory board and invited speaker; BMS Principal Investigator, Clinical Trial CA224-1044; Dizal Prinpial Investigator DZ2022E0005 & DZ2019E0001; Pfizer Principal Investigator, Clinical Trial C4221016 Callejo \u00c1: Astra Zeneca employee. Majem M: Advisory Board or consulting fees: Amgen, AstraZeneca, Boehringer Ingelheim, Beigene, Bristol-Myers Squibb, Helsinn Therapeutics, Johnson & Johnson, Elli Lilly, MSD, Novartis, Pfizer, F. Hoffmann-La Roche Ltd., Takeda, Sanofi, Janssen, Cassen Recordatti. Research funding (institution): Bristol-Myers Squibb, AstraZeneca, F. Hoffmann-La Roche Ltd. Travel and accommodation support: AstraZeneca, F. Hoffmann-La Roche Ltd., Pfizer, MSD The rest of authors do not declare any conflicts of interest. Study sponsored by AstraZeneca Farmac\u00e9utica Spain S.A.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}],"article-number":"471"}}