A New Era in Small Cell Lung Cancer Treatment

Although advancements in treatments for small cell lung cancer (SCLC) are scarce for this aggressive cancer type, recent regulatory developments and trial results indicate that we are on the precipice of a new era for patients and providers alike.

We put a spotlight on these big steps forward and discuss what they mean for the future of SCLC treatment in this seasonal issue of CURE.

“The limited options of treatment for patients with small cell lung cancer is the reality that we all confront — but that is not for lack of trying,” said Dr. Taofeek K. Owonikoko, executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore.

However, a glimmer of hope emerged with the approval of Imdelltra (tarlatamab-dlle) by the Food and Drug Administration (FDA) in May 2024 to treat patients with extensive-stage (ES) SCLC.

This groundbreaking immunotherapy, known as a bispecific T-cell engager therapy, offers an innovative approach to treating SCLC. Imdelltra works by binding to both cancer cells and immune cells, bringing them close together, which activates the immune system to attack and destroy the tumor.

Elsewhere this year, results of the landmark phase 3 ADRIATIC trial of Imfinzi (durvalumab), an immunotherapeutic antibody known as a checkpoint inhibitor, attracted plenty of attention in discussions at the American Society of Clinical Oncology Annual Meeting. The findings have also been published in the Journal of Clinical Oncology.

Imfinzi, which was initially approved by the FDA in 2020 in combination with etoposide and either carboplatin or cisplatin as first-line treatment of ES-SCLC, was tested in ADRIATIC in patients with limited-stage (cancer on one side of the chest only) SCLC and whose disease had not progressed after chemoradiotherapy.

“This is perhaps the only breakthrough advancement in the past 30 years, because we have been using chemotherapy and radiation to treat [patients with] limited-stage small cell lung cancer since more than 30 years ago. However, this is the first time a new treatment has been shown to be able to prolong life for almost two years,” said Dr. Yuanbin Chen of the Cancer and Hematology Centers in Grand Rapids and Norton Shores, Michigan.

Imfinzi blocks the immune-dampening protein PD-L1, thereby helping the immune system detect and attack cancer. Based on the results of the ADRIATIC trial, the FDA has accepted a supplemental biologics license application for Imfinzi and granted priority review, with a regulatory decision expected later this year.

In discussing these developments, we also delve into the side effects associated with these treatments and acknowledge the continued need for a cure for SCLC — one of the more virulent cancers.

“We’re still far, far away from where we need to be, which is, how do we transform cancer from being a very mortal diagnosis to something that people can survive?” said Owonikoko.

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