Outlining the Impact of Immunochemotherapy in First-Line SCLC Subtypes

Numerous trials have examined 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), and their findings have successfully demonstrated benefit, according to Anne Chiang, MD, PhD.

Chiang discussed the benefits of these regimens in an interview with CancerNetwork® following a presentation at the 43rd Annual Chemotherapy Foundation Symposium in New York, New York, hosted by Physicians’ 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 that examined its impact, beginning with the 2018 readout of the phase 3 IMpower133 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 an 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 by emphasizing the rapid evolution of the SCLC space, suggesting 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 frontline [treatments], 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 [American Society of Clinical Oncology Annual Meeting], 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; November 12-14, 2025; New York, NY.
2. Horn L, Mansfield AS, Szczęsna A, et al; IMpower133 Study Group. 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; CASPIAN Investigators. 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; ADRIATIC Investigators. 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; IMforte Investigators. 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