Alissa J. Cooper, MD

Panelists discuss how the next 3 to 5 years will likely see T-cell engagers moving into earlier treatment lines, potential ADCs replacing chemotherapy in first-line therapy, and the critical need for better biomarker testing to optimize treatment sequencing and patient selection in an increasingly complex therapeutic landscape.

Panelists discuss how emerging therapies including DLL3-targeted ADCs, trispecific T-cell engagers, CAR T cells, and radioligand therapies represent promising approaches that may offer single-dose treatments or enhanced efficacy, though more data on durability and optimal sequencing are needed.

Panelists discuss how antibody-drug conjugates targeting B7-H3 show impressive response rates compared to historical controls, while T-cell engagers remain the priority for second-line therapy due to their demonstrated durability, though patient preferences and contraindications may influence individual treatment decisions.

Panelists discuss how tarlatamab implementation requires careful infrastructure planning, including 24-hour monitoring capabilities, staff education about cytokine release syndrome management, patient counseling, and coordination with community partners to ensure all eligible patients have access to this standard-of-care therapy.

Panelists discuss how neutropenia management varies widely across institutions, with some using primary prophylaxis with G-CSF or trilaciclib, while others tailor supportive care based on individual patient risk factors including age, comorbidities, and prior treatment tolerance.

Panelists discuss how monitoring for long-term immunotherapy toxicities requires regular imaging and symptom assessment, with early recognition and treatment of pneumonitis, hypothyroidism, and adrenal insufficiency being critical for maintaining patients on therapy and preventing chronic complications.

Panelists discuss how managing toxicities during chemoradiation requires proactive counseling about esophagitis and fatigue, while immunotherapy consolidation typically doesn’t enhance these acute toxicities, making it feasible to start within the recommended timeframe after completion of chemoradiation.

Panelists discuss how preliminary neoadjuvant chemoimmunotherapy data showing high response rates and pathologic complete responses in limited-stage SCLC appears promising but requires larger studies and careful patient selection given the complexity of staging and surgical candidacy.

Panelists discuss how while emerging biomarkers like inflamed subtypes and MHC class I expression show promise for predicting immunotherapy benefit, current clinical practice treats all patients with immunotherapy since the potential for exceptional responses cannot be reliably predicted.

Panelists discuss how the concerning underutilization of first-line chemoimmunotherapy in extensive-stage SCLC may stem from clinical nihilism, lack of urgency in treatment initiation, and inadequate education about the substantial benefits these therapies provide to patients.

Panelists discuss how pneumonitis risk management requires intensive patient education about symptoms, close monitoring for several months post radiation, and multidisciplinary coordination with pulmonology and radiation oncology teams to distinguish between radiation-induced and immunotherapy-related pneumonitis.

Panelists discuss how patient selection for durvalumab consolidation requires careful consideration of autoimmune diseases, baseline lung function, and neurologic paraneoplastic syndromes, while emphasizing that most patients should receive immunotherapy unless they have severely active contraindications.

Panelists discuss how durvalumab consolidation after chemoradiation has become the standard of care for limited-stage SCLC based on the ADRIATIC trial, with most patients being considered candidates for the 2-year treatment course.

Isabel Preeshagul, DO, MBS, and colleagues share updates from across the lung cancer space as discussed in a recent State of the Science Summit.

Alissa J. Cooper, MD, discusses insights from the TROPION-Lung01 trial that may help guide antibody-drug conjugate use in second-line NSCLC.