Clinical Trials Chip Away at Small-Cell Lung Cancer Defenses

Reported by Neil Osterweil
MDedge News

Clinical Trials Chip Away at Small-Cell Lung Cancer Defenses

Small-cell lung cancer (SCLC), in the words of one leading oncologist, is the “type of disease that gives cancer a bad name.” This aggressive malignancy is most frequently caused by smoking or exposure to secondhand smoke, but is also associated with radiation exposure, occupational exposures, air pollution, HIV, and a family history of lung cancer.

Although SCLC is more sensitive to chemotherapy and radiation than non-small cell lung cancer (NSCLC), the majority of patients (about 70%) are not diagnosed until they have extensive-stage disease, leading to 5-year overall survival rates on the order of only 5% to 10%.

Until recently, despite multiple clinical trials of various combinations and therapeutic strategies, no therapy could be found that worked better than the combination of carboplatin and etoposide.

With the advent of immune checkpoint inhibitors, however, cracks have begun to appear in SCLC’s formidable defense. One checkpoint inhibitor, atezolizumab, has been approved by the US Food and Drug Administration for use in the first-line setting in combination with carboplatin and etoposide for patients with extensive-stage SCLC, and other checkpoint inhibitors, such as pembrolizumab, are being evaluated for treatment of patients with disease progression following second-line or third-line therapies.

Other agents being evaluated for treatment of patients with SCLC include tyrosine kinase inhibitors, antibody-drug conjugates, and novel chemotherapy combinations.

In this interview conducted at the 2019 American Society of Clinical Oncology (ASCO) – Society for Immunotherapy of Cancer (SITC): Clinical Immuno-Oncology Symposium, Lung Cancer Journey asks Leora Horn, MD, MSc, Associate Professor of Medicine, Assistant Director of the Educator Development Program, and Clinical Director of the Thoracic Oncology Program at Vanderbilt University Medical Center, Nashville, Tennessee, about the latest clinical trial data in SCLC, and about the special clinical and research challenges and unmet needs in treatment of SCLC.

Lung Cancer Journey: Dr. Horn, why is SCLC so difficult to treat compared with non-small cell lung cancer (NSCLC)?

Lung Cancer Journey: Has clinical trial enrollment been a problem with this patient population?

Lung Cancer Journey: Could you please summarize findings from the most recent clinical trials in SCLC?

Lung Cancer Journey: What do you see as being the most promising agents or combinations for improving response rates and survival?

Lung Cancer Journey: Finally, what do you see as the most critical unmet needs in SCLC?

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