Overcoming the “Nihilism” Surrounding the Small Cell Lung Cancer Prognosis

Education and communication are key in clearing up the “nihilism” that surrounds the prognosis of patients with small cell lung cancer (SCLC), according to Anne Chiang, MD, PhD.

Chiang, an associate professor of Medicine in the Section of Medical Oncology at Yale School of Medicine, spoke with CancerNetwork® about considerations for optimizing the quality of care of patients with SCLC and other types of lung cancer in a community-based setting. She highlighted how the survival of this patient population has generally improved with the addition of immunotherapy to frontline treatment. To push the envelope and further improve outcomes among patients, Chiang described the necessity of leveraging the field’s understanding of disease biology to impart the benefits of therapy to more patients.

Additionally, Chiang noted how clinical trials in SCLC have become more “pragmatic” with their eligibility criteria than before. For example, more trials appear to allow the enrollment of patients with prior chemotherapy or asymptomatic brain metastases.

Transcript:

Education and communicating the advances that are happening are important. There’s still a bit of nihilism about the prognosis of our patients, and for [SCLC], this is a disease that, 5 years ago, most patients had an overall survival of a year. Now, we’re seeing with the addition of immunotherapy to the frontline regimen, that about 18% make it to 3 years, and for your 5- and 6-year overall survival, you have about 10% of the patients making it there. Obviously, we need to still push that envelope; we need to understand, explore, and leverage our understanding of the biology. How can we impart that benefit to more patients? To do that, we need to get them treated, and we need to get them treated early on. There are trials now that are much more pragmatic than before. I’m seeing those trials that allow patients with brain metastases who are asymptomatic to go on. I’m seeing trials that allow patients to have a first cycle of chemotherapy before they go on to the clinical trial. Both of those are classic elements of clinical trials that patients [typically] couldn’t go on because of that.