Lessons from Real-World Cases of Small Cell Lung Cancer

In season 4, episode 12 of Targeted Talks, Federico Albrecht, MD, oncologist/hematologist at Miami Cancer Institute of Baptist Health South Florida, gives and account of 2 cases of patients with small cell lung cancer (SCLC) and how these patients were treated.

According to Albrecht, the standard of care treatment for SCLC today is the combination of chemotherapy and immunotherapy, and he kept this in mind when selecting a treatment for a difficult case of SCLC.

“I want to highlight the significant progress made in the treatment of small cell lung cancer, with the incorporation of immunotherapy. This development which is the addition of immunotherapy to primary chemotherapy represents the first major advancement in the management of this disease in the last 30 years. So, this is huge. This is very important. As you know, small cell lung cancer is an aggressive and rapidly progressing malignancy. So, while typically respond to initial chemotherapy, the disease often recurs in a matter of months, resulting in a poor prognosis,” says Albrecht.

The advances Albrecht refers to come from the IMpower133 (NCT02763579) and CASPIAN (NCT03043872) studies. In IMpower133, the addition of PD-L1 to standard chemotherapy was shown to improve survival in patients with ES-SCLC. The study specifically assessed the use of atezolizumab (Tecentriq) with carboplatin plus etoposide. Results showed that the immunotherapy/chemotherapy combination achieved a median overall survival of 12.3 months with the addition of atezolizumab vs 10.3 months with chemotherapy alone. The median progression-free survival shown was 5.2 months with atezolizumab and chemotherapy compared with 4.3 months with chemotherapy alone.

The CASPIAN study showed that adding durvalumab (Imfinzi) to platinum-etoposide or of tremelimumab (Imjudo) to platinum-etoposide improved OS in patients with ES-SCLC. The median OS of 13.0 months with added durvalumab vs 10.3 months with platinum-etoposide alone.

“In an era since these studies were first published, the incorporation of immunotherapy has made a big difference and we are seeing those benefits in the clinic,” Albrecht says.

Albrecht also notes that toxicity is important to monitor in these patients. During this Targeted Talks episode, he shares a story of a patient with SCLC who experienced adverse events on treatment.

_REFERENCES:

_{1. Horn L, Mansfield A, Szczęsna A, et al. First-Line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018; 379(23):2220-2229. doi: 10.1056/NEJMoa1809064}

_{2. Paz-Ares L, Dvorkin M, Chen Y, et al. Durvalumab plus platinum–etoposide versus platinum–etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019;394(10212):1929-1939. doi: 10.1016/S0140-6736(19)32222-6}