Immunotherapy Yields Benefits in Select Extensive-Stage SCLC Populations

Commentary
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FDA-approved immunotherapy options such as atezolizumab and durvalumab have produced substantial benefits in certain groups of patients with extensive-stage small cell lung cancer, says Gregory Peter Kalemkerian, MD.

Adding immunotherapy to frontline treatment has been a “major advance” for treating certain patients with extensive-stage small cell lung cancer (ES-SCLC), according to Gregory Peter Kalemkerian, MD.

In a conversation with CancerNetwork®, Kalemkerian, a clinical professor at The University of Michigan, spoke about recommendations for the use of immunotherapy in SCLC management based on updated guidelines from the American Society of Clinical Oncology (ASCO) and Ontario Health (Cancer Care Ontario), of which he was the senior author. He said that data for immunotherapy in patients with limited-stage SCLC are still anticipated, although he predicted the drug class would produce a survival benefit in this population similar to that reported among those with ES-SCLC.

The guideline authors issued a strong recommendation based on high-quality evidence for first-line systemic therapy with carboplatin plus etoposide or cisplatin plus immunotherapy with atezolizumab (Tecentriq) or durvalumab (Imfinzi) followed by maintenance immunotherapy in patients with ES-SCLC who have no contraindications to immunotherapy. Based on an informal consensus, there was no evidence supporting the continuation of immunotherapy for patients with relapsed SCLC who had disease progression on maintenance immunotherapy.

Transcript:

The main advance is with the addition of immunotherapy, particularly PD-1 and PD-L1 agents, into first-line therapy for [patients] with ES-SCLC. Although the number of [patients] who are benefiting is not nearly as high as we would like to see it, clearly the immunotherapy does benefit a small group of [patients] quite substantially. That’s the major advance that we have seen. Thus far, we’ve seen that with atezolizumab and durvalumab, which are FDA-approved agents in combination with chemotherapy. There are a couple of other drugs from studies in other countries that have also demonstrated very similar outcomes with the addition of chemotherapy. That’s the major advance that we have seen.

There are quite a few trials ongoing and some that have been completed, and we’re just waiting for data in limited-stage small cell lung cancer to see what the addition and the integration of immunotherapy does there. We’re hoping that it has an improvement in survival and hopefully an improvement in the long-term cure rate. My guess is that it’s going to be on the order of what we’ve seen in every other scenario with immunotherapy in small cell lung cancer, that it’s going to be in that 10% to 15% range of benefit, which would be a significant improvement. There are also many trials going on looking at how we might optimize and improve immunotherapy additions of other agents with immunotherapeutic. Anti-angiogenics and others are being looked at in quite a few clinical trials. We’re hoping that this will eventually be the base on which we will build further advances.

Reference

Khurshid H, Ismaila N, Bian J, et al. Systemic therapy for small-cell lung cancer: ASCO-Ontario Health (Cancer Care Ontario) guideline. J Clin Oncol. 2023;41(35):5448-5472. doi:10.1200/JCO.23.01435

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