New Approaches to Small Cell Lung Cancer Therapy
Reported by Neil Osterweil
Videography by Patrick Frank
MDedge News
New Approaches to Small Cell Lung Cancer Therapy
Small-cell lung cancer (SCLC) is an extremely aggressive pulmonary malignancy with 5-year overall survival rates of just 5% to 10% with conventional therapeutic regimens. Patients who at the time of diagnosis have tumors confined to the hemithorax of origin, mediastinum, or supraclavicular lymph nodes (limited-stage disease) have a somewhat better prognosis than those with tumors that have spread beyond the supraclavicular areas (extensive-stage disease). Nonetheless, patients with both disease stages have very few effective therapeutic options and will have generally poor outcomes.
With improved understanding of the molecular origins of disease and better knowledge of immunotherapies, however, the grim picture for patients with SCLC is beginning to brighten. Basic and clinical research presented at the 2019 annual meeting of the American Association for Cancer Research (AACR) shows promise for improved understanding of SCLC molecular subtypes and possible targetable mutations, as well as novel approaches for treating SCLC using immune checkpoint inhibitors.
Newly Identified Subtypes and Targets
Trudy G. Oliver, PhD, is an Associate Professor of Oncological Sciences at the University of Utah Huntsman Cancer Institute in Salt Lake City. She moderated a session at AACR 2019 titled “Small-Cell Lung Cancer: A Glimmer of Light at the End of the Tunnel.” In this interview, she discusses her lab’s discovery that the proto-oncogene MYC drives a unique molecular, metabolic, and potentially targetable subset of SCLC. She also describes research by David MacPherson, PhD, from the Fred Hutchinson Cancer Research Center in Seattle into a subtype of SCLC involving deletion of the tumor suppressor CREBBP, and investigations by Christopher Vakoc, PhD, from the Cold Spring Harbor (NY) Laboratory, into a tuft cell variant of SCLC that may be treatable by targeting the master regulator gene POU2F3.
Checkpoint Inhibitor Immunotherapy
Louis M. Weiner, MD, Director of the Georgetown University Lombardi Comprehensive Cancer Center in Washington DC, moderated a briefing at AACR where Hyung Cheol Chung, MD, from Yonsei University College of Medicine in Seoul, South Korea, presented data on the use of the immune checkpoint inhibitor pembrolizumab in patients with advanced SCLC that progressed on two or more prior lines of therapy. Dr. Weiner discusses the promise of immunotherapy in SCLC, where one agent, atezolizumab, has been approved by the US Food and Drug Administration for use in combination with carboplatin and etoposide as a first-line therapy for patients with extensive-stage SCLC.
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