Immunotherapy Advances Transform Small Cell Lung Cancer Care

Immunotherapy is changing treatment strategies for both limited- and extensive-stage small cell lung cancer, explained Dr. Jacob A. Sands in an interview with CURE.

For limited-stage disease, patients now receive immunotherapy after chemotherapy and radiation, with the goal of cure. Sands noted that this approach is well tolerated and improves time to recurrence, with signs it may lead to more patients being cured.

In extensive-stage disease, immunotherapy has been standard for several years, but new developments are bringing further progress. Antibody-drug conjugates are showing promise in later lines of therapy, while Imdelltra (tarlatamab) — which links tumor and immune cells — is now an established second-line option, with some patients experiencing long-term disease control.

“These are just a handful of the advances happening in small cell lung cancer,” Sands said.

Sands is a physician at Dana-Farber Cancer Institute, associate chief of the Lowe Center for Thoracic Oncology, oncology medical director of the International Patient Center, and assistant professor at Harvard Medical School.

Transcript

What are the most significant advances we've seen in recent years for both limited-stage and extensive-stage small cell lung cancer, and how are they reshaping our strategies?

There is a lot going on from a research side in the treatment of small cell lung cancer. It’s horrifying that anyone has to be in a situation where they need these treatments, but academically, it’s exciting to see such advances. In the limited-stage space, we now have the incorporation of immunotherapy after chemotherapy and radiation. This is limited stage where we’re treating with a goal of cure. The standard of care up to this point had been chemotherapy and radiation and then monitoring, and what we’ve found is that by adding two years of immunotherapy — a 30-minute infusion once every four weeks — most patients don’t end up with a lot of side effects. This is something that’s pretty well tolerated, and with that, we see improvement in time to recurrence.

I would speculate that we may actually see an increasing number of patients cured, though we need longer-term data before using those words in a scientific way. But it looks like more patients may be cured, which is of course the real goal, and overall people live substantially longer. This has been a very good signal for how effective the drug is, while not having the same kind of side effects we see from chemotherapy. This has been a huge advance in metastatic, stage 4 disease and now also in the earlier, curative setting.

In the metastatic setting, incorporation of immunotherapy has been an important part of the standard of care for seven or eight years, but we now have much more going on. We also have a targeted chemotherapy called antibody-drug conjugates. Essentially, the antibody finds a target — like a key finding a lock — and that’s how it delivers the chemotherapy. Multiple drugs in development are showing promising results, working for a substantial number of patients in later lines of therapy. First-line treatment reliably works well for most people, but as patients move further along, some classic chemotherapy drugs can still work, though these new agents work better. It’s exciting to see those advances.

We also have immunotherapy in [Imdelltra]. This drug grabs tumor cells by a receptor called DLL3 and immune cells by a receptor called CD3, essentially bringing the immune cells and tumor cells together to create more of an immune response. This has worked remarkably well and is now the established second-line treatment for patients. It has shown very promising results, particularly in that we’re seeing some patients years on with ongoing disease control in that second-line setting.

Transcript has been edited for clarity and conciseness.

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