Poor SCLC Outcomes Observed in Low-Middle-Income Countries

Small cell lung cancer: © Констянтин Батыльчук- stock.adobe.com

Small cell lung cancer (SCLC) often presents itself as a challenge in low-middle-income countries (LMICs), where limited data and resources often are associated with poor outcomes. In a study presented at the 2024 American Society of Clinical Oncology Annual Meeting, experts offer a comprehensive evaluation of the clinical characteristics, treatments, and outcomes associated with patients with SCLC in India.

“​​The recent study highlights the urgent need for more effective treatment strategies for small cell lung cancer, especially in resource-limited settings, where compounding factors such as inadequate screening and harmful lifestyle choices may have contributed to poor survival rates in response to traditional therapeutic approaches,” David Suhy, co-founder and chief scientific officer at Earli, told Targeted Oncology^TM.

SCLC, comprising 15% of lung cancer cases, remains poorly characterized and studied regarding patient outcomes within LMICs like India. This prospective, multicenter study conducted across 6 institutions within the BIRAC-funded Network of Oncology Clinical Trials of India (NOCI) sought to characterize the clinical presentation, treatment patterns, and outcomes of patients with SCLC in a LMIC setting.

Detailed clinicopathological, biochemical, radiological, and treatment data were collected for patients with SCLC who were enrolled in the study from 2018 to 2023. Data was captured in a network cancer registry and included the collection of demographic, clinical, biochemical, immunohistochemical, and radiological data. Progression-free survival (PFS) and overall survival (OS) were assessed as primary end points of the study.

There were 73 patients with SCLC enrolled in the study. The median age of patients was 63 (range, 44-81), 85% of those included were males, 73% were smokers, 29% were alcoholics, 22% were hypertensive, and 15% were diabetic. The most common presentations included cough (67%), chest pain (45%), dyspnea (40%), and hemoptysis (15%).

The median hemoglobin was 13 gm/dL and albumin 3.6 gm/dL. Immunohistochemistry was available for 43 patients. This revealed 83% synaptophysin, 65% chromogranin, and 11% napsin positivity. A total of 66% of patients had extensive stage disease. Forty-five percent had lymph node involvement, 42% had contralateral lung involvement, 30% had pleural effusion, 11% had liver and supraclavicular nodes, 10% had bone metastasis, and 7% had adrenal metastasis.

Fifteen patients had upfront brain imaging done, while 40% of patients had brain metastasis. A total of 94% of patients underwent chemotherapy, of which 62% were given etoposide and carboplatin, 19% were given etoposide and cisplatin, and 19% were given others, including topotecan or single-agent therapy for a mean of 3 cycles. No patients received immunotherapy. Additionally, 28% underwent radiotherapy, and only 6% received upfront surgery.

Findings showed that at a median duration of follow-up of 7 (range, 1-45) months, 68% of patients had died, and the median OS was 5.8 months (95% CI, 2.9-8.6). Median PFS at this last follow-up was 4.1 months (95% CI, 2-6).

Moreover, 13% of patients had significant chemotherapy-related acute toxicity, and 50% had progression after being treated in the first-line setting.

While Suhy did not work on the study, he explained the work being done by Earli to address these long-standing challenges faced by many cancer institutions and oncologists.

​​"At Earli, we are committed to addressing these challenges by developing innovative solutions that tap into the molecular pathways that lead to the underlying malignancy and are designed to force cancer cells to both illuminate or self-destruct, which significantly enhances cancer visibility and eradication,” explained Suhy.

Overall, this study underscores the significant unmet clinical needs of patients with SCLC, particularly patients in LMICs. With a study population that exhibited aggressive disease characteristics and a high burden of metastatic disease, investigators found limited surgical options to be available, highlighting the reliance on chemotherapy and the absence of immunotherapy in this setting.

The poor response and survival outcomes observed in this study emphasize the critical need for innovative treatment strategies for patients with SCLC in LMICs.

“Because Earli’s platform can be directed towards early detection or targeted treatment, our technology represents a significant advancement in the fight against aggressive cancers like SCLC. By turning cancer cells against themselves, our method is not only designed to improve the accuracy of detection but can also be used to actively engage in eliminating the cancer. This solution addresses both the identification and treatment of lung cancer, offering new hope for patients where traditional methods have fallen short," Suhy concluded.

REFERENCE:

Kapoor M, Sehrawat A, Phillips AO, et al. Unveiling the challenges of small cell lung cancer in resource-limited settings: A multicenter collaboration analysis of demographics, treatment modalities, and prognosis. J Clin Oncol. 2024;42(suppl 16):e20103. doi:10.1200/JCO.2024.42.17_suppl.e20103