First- and Second-Line Treatments in SCLC

Ariel Lopez-Chavez, MD, medical oncologist, director of precision medicine and developmental therapeutics at Allegheny Health Network Cancer Institute, discusses available frontline options for patients with small cell lung cancer, then moves into second-line treatments.

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0:10 | In the frontline setting, we have carboplatin or cisplatin and etoposide plus either atezolizumab [Tecentriq] or durvalumab [Imfinzi] for 4 to 6 cycles, followed by atezolizumab or durvalumab as a maintenance therapy until disease progression. So that's what we have as FDA-approved agents in the first-line setting. In the second-line setting, we essentially have lurbinectedin [Zepzelca] and topotecan as FDA-approved agents.

0:37 | Talking in particular about lurbinectedin, the safety and efficacy of this agent was very good. In a basket trial, it was observed to have an overall response rate of 35%, a median progression-free survival 3.5 months, and a median overall survival 9.3 months, and essentially, based on this efficacy, it has gained its approval by the FDA in the second-line setting for small cell lung cancer.

1:07 | Now, the particular part that is important to highlight is the safety profile, right? We have myelosuppression as 1 of the main [adverse] effects of these therapies. We have a grade 3 and 4 neutropenia rate of about 41%, and a febrile neutropenia rate of 74%. This is significant, however, the only other option that is FDA-approved is topotecan and topotecan has double the rate of myelosuppression in this case, or more. Then we're talking in regards to safety, we have like half the myelosuppression that we have with topotecan, so in this regard, it's a very attractive option for the second-line setting. Now, we're not there yet. This is significant. myelosuppression, 41%, grade 3/4 neutropenia and 74% of febrile neutropenia still is not great, but at least this is an improvement compared with what we had before which was only topotecan as the only other FDA-approved agent in the second-line setting.