Immunotherapy Offers Certain Patients With Small Cell Lung Cancer A ‘Ray of Hope’, Expert Says

Recent developments in immunotherapy treatment have given patients with extensive-stage small cell lung cancer something to have faith in, according to an expert from City of Hope.

“Having been in practice for 30 years, we didn’t really see that kind of advancements in small cell lung cancer as compared to non-small cell lung cancer,” Dr. Ravi Salgia, a medical oncologist and Arthur & Rosalie Kaplan Chair in Medical Oncology at City of Hope in California, said during CURE®’s Educated Patient® Lung Cancer Summit. “But immunotherapy is now giving us a ray of hope, or light at the end of the tunnel.”

However, as Salgia suggested, more research is still needed to further develop treatment options for patients with limited- (confined) and extensive- (metastatic) stage small cell lung cancer.

“I think we shouldn't be happy with what we have for small cell lung cancer ... we know that we can do better,” he exclaimed. “How do we do better? We have to go back to the laboratory; I can't emphasize enough that lung cancer research has to be supported.”

During the summit, Salgia highlighted advances in the first- and second-line treatment of small cell lung cancer. He noted that small cell lung cancer, which accounts for approximately 15% of lung cancer diagnoses, may be fast growing, aggressive and is sometimes difficult to treat.

First-Line Treatment Options

Salgia explained that although the disease can be difficult to treat, limited- and extensive-stage disease should be treated differently.

For instance, treatment for limited-stage small cell lung cancer may include the combination of chemotherapy drugs, such as etoposide plus cisplatin. This combination would be given in moderately intensive doses, according to Salgia, however no benefit is observed after four to six cycles of treatment.

Another treatment option is radiation therapy, which Salgia stated is “incredibly important.” It can improve local control of the disease and, he noted, may increase 2- or 3-year survival rates by 5%. It is most effective when given early and with chemotherapy, however, some studies show increased toxicity.

Salgia also touched upon prophylactic cranial radiation, which has been effective in preventing the cancer from spreading to the brain.

For extensive-stage disease, some of the combined therapies include:

• Tecentriq (Atezolizumab) plus carboplatin plus etoposide with maintenance Tecentriq
• Imfinzi (Durvalumab) plus carboplatin/cisplatin plus etoposide with maintenance Imfinzi
• Carboplatin/cisplatin plus etoposide
• Carboplatin/cisplatin plus Onivyde (irinotecan)

Small cell lung cancer may respond to initial treatment with chemotherapy and radiation, but recurrence is an important issue to highlight, Salgia noted. After first-line treatment is completed, there are still persistent cancer cells that can grow over time. Five-year survival rates for patients with limited-stage disease hover around about 20% to 30%, and is only around 2% to 6% in extensive-stage disease. Most patients in this population, Salgia noted, relapse with a poor prognosis.

Second-Line Treatment Options

Before starting second-line treatment, it must be identified where a patient’s disease progressed from since their last treatment and what options are available.

One of the most recent second-line treatment options approved for patients with metastatic disease, according to Salgia, was Zepzelca (lurbinectedin). This was approved based on results from a trial that demonstrated that the drug induced a 35.2% overall response rate (a percentage of patients with a partial or complete response to treatment) in patients with platinum-sensitive and -resistant or relapsed small cell lung cancer.

He noted that there are ongoing trials currently testing if Zepzelca has efficacy as a first-line therapy or in combination with other therapies.

Hope for the Future

Salgia also stressed the importance of enrolling in clinical trials because more information can be gathered, and it creates hope for the future.

“A lot of people are doing great investigations to be able to help patients who have small cell lung cancer,” he said. “And (doctors) want to make sure that we can arrive at great therapies like we have for some of the non-small cell lung cancer, and we shouldn't sit still until we come up with that.”

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