Leveraging Biology to Advance the Small Cell Lung Cancer Treatment Paradigm

In a discussion with CancerNetwork^®, Anne Chiang, MD, PhD, spoke about the current treatment landscape for those with small cell lung cancer (SCLC) as well as next steps for elevating the quality of care among patients. She began by outlining the evolution of therapeutic standards in the field, with atezolizumab (Tecentriq)- and durvalumab (Imfinzi)-based regimens emerging as key frontline strategies and lurbinectedin (Zepzelca) and tarlatamab-dlle (Imdelltra) demonstrating utility as second-line therapies.

Regarding novel treatments that may hold promise in the SCLC field, Chiang, an associate professor of medicine in the Section of Medical Oncology at Yale School of Medicine, highlighted her work on the phase 2 SWOG S2409 PRISM trial (NCT06769126). Here, Chiang and colleagues plan to collect tissue from more than 800 patients undergoing frontline induction therapy with chemoimmunotherapy to inform subsequent biomarker-directed treatment, which may help elucidate factors of disease heterogeneity in the process.

The conversation also focused on considerations for improving the care of those with lung cancer in community-based settings, as Chiang emphasized spreading knowledge of therapeutic advances to a broader patient population. She noted that there is “still a bit of nihilism about the prognosis” of patients with SCLC, describing a need to further leverage the field’s understanding of biology to impart the benefits of immunotherapy to more patients. Chiang also detailed the importance of employing patient-reported outcomes to hear directly from the patient, which may ensure their inclusion in the shared decision-making process and optimize strategies for mitigating potential adverse effects during treatment.

“Understanding and leveraging the biology is important. We are going to need to understand how to sequence therapies, and that involves understanding which patients are at higher risk,” Chiang stated regarding future initiatives in the field. “We need to look at high-risk populations—for example, patients with brain metastases—and understand which therapies are especially useful for them.”