Leach’s Insights on Advancements and Challenges in SCLC Treatment

Joe Leach, MD, medical oncologist, associate medical director for quality and safety at Allina Health Cancer Institute, discusses how comprehensive biomarker testing has impacted treatment selection for patients with small cell lung cancer.

He then explains how one can best navigate treatment decisions and potential combination therapies in this space with the number of potential targets that are available growing.

Transcription:

0:09 | It has had a gigantic impact on the way we think about and treat non-small cell lung cancer. Unfortunately, it has not had that much of an impact in small cell lung cancer. Certainly, we know that there are commonly seen mutations in small cell lung cancer, primarily retinoblastoma and TP53, but unfortunately, we just do not have effective therapies for those. Occasionally we will find an actionable mutation in small cell lung cancer, but it really is not standard of care to do [next-generation sequencing (NGS)] testing; although, I would say most oncologists do at some point. It, unfortunately, has not been very beneficial in terms of finding active therapies.

0:56 | The challenge with small cell, frankly, is we have not moved the needle very much in a long time. The standard therapy since I started practice 25 years ago was platinum etoposide. The standard therapy now is platinum etoposide with 1 addition of incorporating checkpoint inhibitors in patients with extensive-stage small cell lung cancer. And we have not made a big impact on survival. Survival has not changed very much.

1:26 | Now, there has been a lot of excitement about potential targeted therapies, with 1 in particular, that we are hoping to see approved by the FDA this year, specifically a bispecific antibody, so it has been a lot of work trying to identify targetable pathways. DLL3 has probably been the most promising and the 1 of greatest interest, although that also has been kind of not completely successful today. I would say there is still a lot of interest in finding targeted pathways, but none that has changed practice.