Assessing the Small Cell Lung Cancer Treatment Landscape - Episode 6

Small Cell Lung Cancer Clinical Trials

Kristie L. Kahl: To start, since small cell lung cancer can have its challenges, why are clinical trials so key when it comes to this disease type?

Wade T. Iams, MD: Clinical trials are critical in individuals with small cell lung cancer, I would say, for 2 broad reasons. And the first part, really, I would argue, cannot be overstated. Individuals participating in clinical trials are contributing tumor and blood for further research that is going to be applicable not only to the clinical trial they're enrolled in, but for future studies. And so that part is essential where those individuals are essentially contributing to a very broad swath of future development.

The second component of clinical trials is the evaluation of a new drug in that particular individual and trying to see if that new drug can better control small cell lung cancer. So, thinking of clinical trials with those 2 pillars, and both being critically important, we hope that new therapies can improve outcomes. It has been very difficult to achieve better outcomes with many clinical trials in small cell lung cancer. And when we're having difficulty improving outcomes for patients with a disease, I would argue it's just as if not more important to have patient specimens, as many as possible to study and learn from so that we can inform many different clinical trials in the future.

Kristie L. Kahl: Can you discuss the targeted therapies that might be evaluated in small cell lung cancer right now?

Wade T. Iams, MD: There are several different groups of targeted therapies that are typically pills or non-chemotherapy, non-immunotherapy treatment options in patients with small cell lung cancer that are still in development. The broad categories that they fit into are seeking to block cell growth through epigenetic modification, which is referring to a broad modality that cells use to grow or specific cell cycle blocking pills. It's difficult to describe the mechanism of each category of targeted therapy that's being evaluated in patients with small cell lung cancer. But we are trying to find ways to use pills that are a bit more targeted to cancer compared to normal cells in individuals with small cell lung cancer.

So far, the difficulty if we say we're going to use a pill that broadly blocks cell growth, or we're going to use a pill that interferes with the cell cycle, 1 specific protein within the cells or 1 specific family of proteins within the cells, those strategies so far in individuals with small cell lung cancer, when we look at people across the board have been have not been very successful in shrinking small cell lung cancer.

The field of targeted therapies in individuals with small cell lung cancer is moving towards a more specific application of these targeted therapies. And what I mean by that is trying to use that clinical trial data where, for most patients, we didn't achieve shrinkage. But to learn from that and see, are there subgroups of patients with small cell lung cancer who did derive benefit from targeted therapies? Can we put together a group of patients who had very similar tumors to those who derived benefit from targeted therapies and potentially link those oral targeted therapies to subgroups of patients with small cell lung cancer?

Kristie L. Kahl: Are there any other areas that are being evaluated right now in the disease state?

Wade T. Iams, MD: One of my particular areas of research interest is finding ways that we can monitor small cell lung cancer in the bloodstream to improve care. So, using blood tests, or liquid biopsies, to monitor small cell lung cancer. I am hopeful we can provide helpful insights into the management (of small cell lung cancer) and that would that could apply to individuals treated with really anything from surgery where, perhaps, a blood test could help determine, in borderline cases, is this individual eligible for surgery? Do we detect concern for cancer elsewhere in the body when we do a blood test? Everything from individuals with recurrent small cell lung cancer receiving chemotherapy that can be effective in subgroups of people, but is most often not effective. And we typically are checking that by a CAT scan 2 months after they start treatment. And the most common question, and rightfully so, from patients and families that we encounter in the clinic, after we give 1 dose of chemotherapy is, is it working? Because that individual and family want to know and have informed decision making about the pros and cons of continuing treatment, that always comes along with some additional side effects? And so everything from how aggressive can we be? Can that be informed by blood tests for small cell lung cancer to? How much are we achieving at the end-of-life care for these patients? Can that be informed by a blood test? And could it tell us after 1 dose, is this chemotherapy working or is it not working? And that can help better inform patients and families as quickly as possible about further treatment decisions?

Kristie L. Kahl: We're making progress in this space, and there was an approval last year, so what can we look forward to most in 2021 within the treatment of small cell lung cancer?

Wade T. Iams, MD: The biggest component in 2021 that I am looking towards is whether we're going to see any results from the use of immunotherapy and people with small cell lung cancer that we're treating for cure. So, particularly individuals who receive chemotherapy and radiation and are going on to receive immune therapy with a goal of improving cure rates. Those trials have been ongoing for a few years now. And there's a possibility that we could see some data in 2021. I'm not sure, but I'm hopeful. I'm very curious to see the role that immune therapy may be able to play for patients who are going for cure and small cell lung cancer.