Clinical Trials: Novel Approaches in Second-Line ES-SCLC
Panelists discuss how first-line chemoimmunotherapy has become the standard for extensive-stage small cell lung cancer (ES-SCLC) based on trials such as IMpower133 and CASPIAN, while emerging agents such as DLL3-targeted therapies show promise in the relapsed setting, highlighting the need for personalized approaches and continued clinical trial participation.
Summary for Physicians:
First-Line Trials:
- IMpower133
- Atezolizumab plus carboplatin/etoposide
- Improved overall survival (OS): 12.3 vs 10.3 months
- Progression-free survival (PFS) benefit; manageable safety profile
- CASPIAN
- Durvalumab plus platinum/etoposide
- OS benefit: 13.0 vs 10.3 months
- Triplet (with tremelimumab): no added benefit, more toxicity
Second Line and Beyond:
- DeLLphi-301
- Tarlatamab (DLL3-targeting bispecific)
- Promising response rates in relapsed small cell lung cancer
- Cytokine release syndrome observed; mostly low grade
- IMforte
- Atezolizumab maintenance post first line
- No significant OS/PFS improvement
- Safety consistent with prior data
- DAREON-8
- Dareonimab in later-line setting
- Early data: modest activity, favorable safety
- Awaiting mature efficacy results
Impact on Treatment Strategies:
- Chemotherapy plus PD-L1 inhibitors: standard first-line
- Limited options post progression
- Novel agents (eg, DLL3 targeted) offer new hope
Emphasis on personalized treatment and clinical trials
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