Key Signs of SCLC Transformation in Patients With EGFR+ NSCLC

Ravi Salgia, MD, PhD, medical oncologist, professor, and chair, Department of Medical Oncology & Therapeutics Research, and Arthur & Rosalie Kaplan chair in Medical Oncology & Therapeutics Research at City of Hope Comprehensive Cancer Center, discusses the ways in which oncologists can watch out for non-small cell lung cancer (NSCLC) that transforms to small-cell lung cancer (SCLC).

According to Salgia, there are not always durable responses with EGFR tyrosine kinase inhibitors (TKI) in patients with NSCLC. Data from preclinical research has even demonstrated resistance to these inhibitors and has shown that NSCLC will transform to SCLC in 5% to 7% of cases.

To further explore the potential for this transformation, Salgia, along with other researchers at the City of Hope Medical Center, examined a novel PP2A inhibitor, LB-100 combined with chemotherapy or immunotherapy, as treatment for these patients. Further, a clinical trial (NCT04560972) observed 9 patients who had EGFR-positive NSCLC and were treated with either erlotinib (Tarceva), afatinib (Gilotrif), or osimertinib (Tagrisso).

In order to keep an eye on these patients, Salgia notes the importance of watching out for cancer which is growing relatively fast with TKI therapy, and reminds oncologists to perform biopsies, histology evaluations, and molecular evaluations to watch the transformation to SCLC.

Transcription:

0:08 | Watch out for cancer that is growing relatively fast with the tyrosine kinase inhibition. We know that patients respond beautifully when they have an EGFR mutation in non–small cell lung cancer, to tyrosine kinase inhibition. But there may come a time when you're seeing progression, and you can't explain this rapid progression.

0:31 | We always say whenever there's progression to biopsy the sample, because you have to look at it under the microscope, you can't do a liquid biopsy, because it doesn’t show the transformation, you have to look at it under the microscope. The only way you can do that is by doing an actual biopsy. Look out for when you do see the scans and progression, do get a tissue biopsy and do a histology evaluation, as well as molecular evaluation.