Outlining the Impact of Immunochemotherapy in First-Line SCLC Subtypes

Numerous trials have examined and successfully demonstrated benefit with the addition of immunotherapy to chemotherapy in the frontline setting among patients with various small cell lung cancer (SCLC) subtypes, including limited-stage (LS-SCLC) and extensive-stage (ES-SCLC), according to Anne Chiang, MD, PhD.

Chiang discussed the benefits of these regimens in an interview with CancerNetwork® following a presentation at the Chemotherapy Foundation Symposium (CFS), hosted by Physician’s Education Resource®, LLC, where she spoke about “Cases and Conversations: Transforming Small Cell Lung Cancer Treatment Through Emerging Evidence and Expert Insights (Spotlight CE Session).”¹ Therein, she described evidence supporting multiple treatment modalities, including immunotherapy, targeted therapy, and chemotherapy among patients with SCLC.

Regarding the addition of immunotherapy to chemotherapy, Chiang listed multiple trials which examined its impact, beginning with the 2018 readout of the phase 3 IMpower trial (NCT02763579), which revealed an overall survival (OS) benefit among patients with ES-SCLC who received atezolizumab (Tecentriq) vs placebo plus carboplatin and etoposide (P = .007).² Furthermore, she highlighted 2019 results from the phase 3 CASPIAN trial (NCT03043872) which demonstrated an OS benefit with durvalumab (Imfinzi) vs placebo with platinum/etoposide in an ES-SCLC population (P = .0047).³

For more recent data, Chiang pointed to results from the phase 3 ADRIATIC trial (NCT03703297), which displayed a near 2-year OS benefit with durvalumab vs placebo among a LS-SCLC population (P = .01).⁴ Finally, she highlighted emergent data from the phase 3 IMforte trial (NCT05091567), which demonstrated an OS benefit with the addition of lurbinectedin (Zepzelca) with atezolizumab among patients with ES-SCLC.⁵

Chiang, an associate professor of Medical Oncology and Thoracic Oncology, as well as the Associate Cancer Center Director of Clinical Initiatives at Yale School of Medicine, concluded in emphasizing the rapid evolution of the SCLC space, suggested that despite unmet needs being present, researchers will continue to advance research to bolster patient outcomes.

Transcript:

Small cell lung cancer is an area where you can see, within the past 5 years, how the front line, or our standard of care treatments, have changed because of research results from clinical trials. [In] 2018 the first [results were presented from the] IMpower133 trial that led to including atezolizumab with the platinum doublet, followed by atezolizumab in the maintenance setting. Then shortly thereafter, in 2019 was the CASPIAN trial that did the same for durvalumab. Then, last year, we [received] the results of the ADRIATIC trial that showed almost a 2-year benefit of OS for patients [receiving] 2 years of durvalumab after concurrent chemoradiation. This year at ASCO, we [had] the IMforte trial, which showed that [there is] a 3-month OS benefit by adding lurbinectedin for select patients in combination with atezolizumab in the maintenance setting.

This field is changing fast. It is [quite] exciting for our patients. There are still unmet needs, but I have confidence that we are going to continue to make progress.

References

1. Rudin CM, Chiang A, Sands JM. Cases and conversations: transforming small cell lung cancer treatment through emerging evidence and expert insights (Spotlight CE Session). Presented at: 43rd Annual Chemotherapy Foundation Symposium (CFS); November 12-14, 2025; New York, NY.
2. Horn L, Mansfield AS, Szczęsna A, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Eng J Med. 2018;379(23):2220-2229. doi:10.1056/NEJMoa1809064
3. Paz-Ares L, Dvorkin M, Chen Y, et al. Durvalumab plus platinum–etoposide versus platinum–etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019;394(10212):1929-1939. doi:10.1016/S0140-6736(19)32222-6
4. Cheng Y, Spigel DR, Cho BC, et al. Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer. N Engl J Med. 2024;391(14):1313-1327. doi:10.1056/NEJMoa2404873
5. Paz-Ares L, Borghaei H, Liu SV, et al. Efficacy and safety of first-line maintenance therapy with lurbinectedin plus atezolizumab in extensive-stage small-cell lung cancer (IMforte): a randomised, multicentre, open-label, phase 3 trial. Lancet. 2025;405(10495):2129-2143. doi:10.1016/S0140-6736(25)01011-6