Immunotherapy for Patients With Small Cell Lung Cancer
Deborah Doroshow, MD, PhD, Mount Sinai Health System, New York, New York, discusses the role immunotherapy plays in the treatment of patients with small cell lung cancer (SCLC).
Transcript:
Hi there, I'm Deborah Doroshow. I am an associate professor of medicine at the Icahn School of Medicine at Mount Sinai and we're here at the Great Debates in Solid Tumors conference. This morning I spoke about the role of immunotherapy in patients with small cell lung cancer.
We talked not only about the approved indications for immune checkpoint inhibitors for patients with both limited- and extensive-stage small cell but also talked about new targets like B7H3, new types of drugs like BiTEs [bispecific T-cell engagers] including tarlatamab and other BiTEs and TriTEs [trispecific T-cell engagers] in development, and certainly addressed the new types of side effects we need to look out for with new classes of medicines but, I think this is probably the most optimistic I've been about small cell lung cancer in a long time and I really look forward to seeing these trials read out.
We know from the studies that were done in patients with extensive-stage disease that the median overall survival improves by about 2 months when you add immunotherapy to chemotherapy. That's not a lot. There are certainly a group of patients who survive for a particularly long period of time, but we know that patients with brain metastases unfortunately have worse outcomes, and this has been the case in my clinical practice as well. We know that there are certainly patients who benefit, but there are many who have limited benefit from these treatments.
The 4 transcriptional subtypes of small cell have been really well elucidated, and there is a SWOG trial in development right now that will actually seek to subtype patients in real time and then assign them to treatment arms based on that biomarker, I'm very excited about that. It remains to be seen how quickly we can do this, but I think it sets up a terrific model for small cell research going forward.
I think that patients with brain metastases seem to have a really tough time, I've certainly had a lot of patients who had limited-stage disease and then rapidly developed brain metastases after receiving definitive chemoradiation so it's very important to surveil patients very closely with frequent brain MRIs to make sure we're not missing that. The second thing that I mentioned is that with the rise of BiTEs like tarlatamab we're now seeing a completely new set of side effects, particularly CRS [cytokine release syndrome] and ICANs [immune effector cell-associated neurotoxicity syndrome] and luckily we have colleagues in hematology who are very, very familiar with these side effects and I urge you to lean on those colleagues and develop very clear pathways for managing, diagnosing these conditions.
Source:
Dorshow D. Immune checkpoint inhibitors in small cell lung cancer: Understanding the evolving landscape and addressing ongoing challenges. Presented at Great Debates in Solid Tumors. March 22-23, 2025; New York, NY.
