Immunotherapy Advances in Small Cell Lung Cancer Treatment

Joe Leach, MD, medical oncologist, associate medical director for quality and safety at Allina Health Cancer Institute, discusses some of the latest developments in incorporating immunotherapy into small cell lung cancer treatment regimens.

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0:10 | The biggest demonstration of improved [progression-free survival] is in patients with extensive-stage, and also advanced small cell lung cancer, in combination with chemotherapy. There was initially a lot of excitement about checkpoint inhibitors, either given alone or as combination therapy based on some earlier phase 1 and phase 2 data. Unfortunately, they turned out not to be quite as active as we had hoped, particularly single agents in both upfront and in second- and third-line therapy.

0:46 | For example, the combination of PD inhibition along with CTLA4 inhibition, dual checkpoint inhibitor therapy, was promising, but those studies ended up being negative when done in a more rigorous way. The 1 that has panned out is combination therapy with chemotherapy and checkpoint inhibitors. We have 2 checkpoint inhibitors approved in that setting and that has made some improvements. As immunotherapy is in most settings for those who benefit, it can be a tremendous benefit, and in those where it does not work, there can be no benefit. That has been the 1 area that we have made some progress, but more needs to be done.

1:28 | One thing that I think there is a lot of interest in is that most lung cancers are not 1 entity, so there have been some subsets identified through gene expression analysis showing that there is an inflamed type of small cell lung cancer that probably benefits more from immunotherapy. That has not quite changed practice yet, but there is obviously a lot of investigation trying to identify those kinds of subsets of patients that we can treat differently.