Updates in the Treatment of Patients With Small Cell Lung Cancer

At the 2023 Great Debates and Updates Conference in Chicago, Illinois, Rebecca Heist, MD, Massachusetts General Hospital, Boston, MA, discusses developments and advances in the treatment of small cell lung cancer (SCLC).

Dr Heist focused on the addition of immunotherapy to chemotherapy in the first-line setting, second-line options, and the future of targeted therapy for this patient population.

Transcript

Hi. I'm Rebecca Heist. I'm a medical oncologist at Mass General in Boston. I'm incredibly excited to be here at the 2023 Great Debates in Lung Cancer in Chicago, Illinois, to talk about small cell lung cancer. This is an area where we've seen a lot of new development. After decades of not having anything new in small-cell lung cancer, we're finally starting to see advances. It's a great time in terms of new therapies for our patients and great research being done.

One of the most important advances that we've seen in the last few years is the addition of immunotherapy to chemotherapy in the first-line setting. For years, platinum etoposide was the first line regimen that we used for treatment of extensive small-cell lung cancer. Over the past few years, we've seen that the addition of checkpoint inhibition can really improve outcomes in that setting. Both IMpower133 and CASPIAN were studies that added PD-L1 inhibitors, atezolizumab or durvalumab respectively, to chemotherapy, and both showed improvements in overall survival. The exciting thing about that is the long-term outcomes that we can see where we see more and more people living years out on-treatment, which is an amazing thing.

In the second-line setting, we're also seeing advances. We of course can reuse platinum doublets if there has been sufficient time from prior exposure. Topotecan has been around for a long time. Lurbinectedin has accelerated approval based on a phase 2 study where we saw good activity. There are advances in that setting as well.

Most excitingly for me, there is a lot of research going on now in small cell lung cancer. Many groups are describing differential expression of transcription factors in small cell lung cancer, where we're starting to see that small cell lung cancer isn't just one disease, but probably multiple different diseases that have different sensitivities to drugs. This is still an evolution, but my hope would be that in future trials and future drug development, we're able to tailor therapy in a more targeted way to small cell lung cancer.

Source:

Heist, R. “Finally Moving Forward in SCLC: The Pace of Progress is No Longer Glacial.” Presented at Great Debates & Updates in Lung Cancers. May 4-6, 2023; Chicago, IL