Treatment Options in Small Cell Lung Cancer
Kartik Konduri, MD, discusses treatment options for extensive-stage small cell lung cancer.
Kartik Konduri, MD: Small cell lung cancer which is extensive-stage disease has been defined to have a certain terminology that allows us to tell the pace of the disease, and its possible sensitivity to next line of treatment. We use terminologies like refractory disease for patients who are in frontline treatment and have progressed. After progression, if the patient has a chemotherapy-free interval of less than 90 days, we consider them to have a resistant relapse. If they have a relapse more than 90 days after the initial chemotherapy, then we consider them to have a sensitive relapse. And those who have very late relapses of more than 180 days are considered to have a sensitive disease that might potentially be treatable with frontline therapy again. This is also known as a rechallenge where data in the past has suggested that such patients who relapse after 180 days might have a significant benefit in their outcomes when challenged back with a frontline regimen.
We consider utilization of second-line treatment in patients who have progression, but we tailor it to be considerations for frontline treatment to be rechallenged, especially in patients who have a relapse more than 180 days. Their data has suggested that these patients may have yet another significant response when a rechallenge occurs if they have a late relapse of their disease.
For patients who relapse earlier than 180 days the considerations include the use of second-line chemotherapy options, and those options include, amongst other things, topotecan, and now the new option of lurbinectedin.
My personal experience with lurbinectedin mirrors the data that came from the basket trial. The drug seems, in my experience, to be relatively well tolerated. In the small number of patients that I have treated, the long-term efficacy is still to be determined.
Transcript edited for clarity.
Case: A 68-Year-Old Woman with Extensive-Stage Small-Cell Lung Cancer
Initial Presentation
- A 68-year-old woman presented with fatigue and a cough
- PMH/PSH: hysterectomy at age 55
- SH: 55-pack year smoking history
- PE: decreased breath sounds in the left lung, cervical lymph node enlargement
Clinical Workup
- Labs: WNL
- Lymph node biopsy showed small cell carcinoma
- Chest/abdomen/pelvic CT showed a 7.4 cm mass above the diaphragm, a small contralateral lung nodule and evidence of invasion into the left side of the pericardium
- PET scan showed activity in both lungs, above the diaphragm with small hypermetabolic activity in the surrounding area
- Contrast‐enhanced MRI of the head was negative for brain metastases
- Stage IV extensive-stage small-cell lung cancer; ECOG PS 0
Treatment
- Initiated carboplatin + etoposide + atezolizumab for 4 cycles; followed with atezolizumab as maintenance therapy
- Repeat CT scan showed a suspicious hepatic mass
- Initiated lurbinectedin 3.2 mg/m2 IV q21 Days
