Jacob Sands, MD

Dr. Sands discusses geographic and practice setting variations, noting lurbinectedin presents no administration challenges anywhere, whereas tarlatamab's rollout has been slower, initially concentrated in academic centers with clinical trial experience managing T-cell engagers and cytokine release syndrome.

Dr. Shields addresses choosing between atezolizumab-based (IMpower133) and durvalumab-based (CASPIAN) induction regimens, noting both demonstrate similar OS benefits (approximately 2.5-3 months) with real-world data showing general equipoise between agents.

Dr. Sands addresses the NCCN footnote stating lurbinectedin cannot be reused after relapse following maintenance use, comparing this to how progression on one PD-L1 inhibitor doesn't necessarily preclude using another.

Dr. Shields discusses trilaciclib, an FDA-approved supportive care medication from 2021 that prevents myelosuppression across red cells, white cells, and platelets, plus neutropenia.

Dr. Leal outlines current decision-making, noting lurbinectedin plus atezolizumab represents the approved standard frontline maintenance strategy for patients tolerating induction well, achieving stable disease or response, and motivated for treatment intensification.

Dr. Chiang addresses whether tarlatamab used in maintenance retains efficacy if used again after progression, acknowledging significant unknowns regarding resistance mechanisms for novel T-cell engager therapies compared to better-understood chemotherapy resistance.

Dr. Sands argues that successful second-line agents should move earlier in treatment sequencing, citing precedent from other oncology fields. With only 40% to 50% of patients with ES-SCLC receiving second-line therapy due to rapid disease progression, declining functional status, or brain metastases, moving effective agents like tarlatamab earlier addresses this attrition problem.

Dr. Shields addresses limitations of phase 1b single-arm studies, noting smaller patient numbers may introduce selection bias toward patients most likely to benefit from T-cell engager therapy targeting DLL3 and CD3. She emphasizes the importance of randomized phase 3 data for head-to-head comparisons, particularly given that DeLLphi-303's control arm involved immunotherapy alone, preventing cross-trial comparisons with IMforte's different control arm.

Dr. Sands discusses tarlatamab's unique mechanism as a bispecific T-cell engager linking DLL3 on tumor cells to CD3 on T cells, creating an antigen-directed immune response distinct from other therapeutic approaches. He characterizes the second-line DeLLphi-304 trial as establishing an entirely new paradigm, representing the only example of one drug outperforming others in SCLC's second-line setting across PFS, OS, tolerability, and symptom improvement.

Dr. Leal discusses practical logistics of lurbinectedin plus atezolizumab, administered together every 21 days. She incorporates maintenance discussions into initial treatment planning, particularly important for patients traveling long distances with caregivers. Most patients with ports prefer intravenous administration despite subcutaneous atezolizumab being an option with comparable efficacy, safety, and drug levels but shorter infusion time.

Dr. Shields confirms that NCCN guidelines now recommend lurbinectedin plus atezolizumab as preferred maintenance therapy following 4 cycles of chemotherapy and immunotherapy, with the specific footnote limiting this to patients with ECOG performance status 0 to 1 and no history of brain metastases. She strictly follows the brain metastasis exclusion criteria for treatment-naive patients but notes this restriction wasn't applied in second or third-line relapse settings.

Dr. Joshua Sabari introduces the program on evolving maintenance and sequencing strategies in extensive-stage small cell lung cancer (ES-SCLC), joined by Dr. Anne Chiang from Yale, Dr. Jacob Sands from Dana-Farber, Dr. Misty Shields from Indiana University, and Dr. Ticiana Leal from Emory University's Winship Cancer Institute.

Dr Sands discusses the rapidly evolving treatment landscape for SCLC.

In this final segment, Dr. Sands asks Dr. Cooper to discuss how subcutaneous administration of targeted therapies may influence clinical practice in EGFR-mutated non-small cell lung cancer.

In this segment, Dr. Sands asks the panel to discuss the emerging role of TROP2-directed antibody–drug conjugates in EGFR-mutated non-small cell lung cancer. Dr. Wakelee and Dr. Cooper explain that these agents are designed to target the TROP2 antigen on tumor cells and deliver a cytotoxic payload, enabling selective tumor cell killing.

In this segment, Dr. Sands asks Dr. Wakelee to discuss how emerging data on MET-driven resistance mechanisms are shaping second-line treatment decisions in EGFR-mutated non-small cell lung cancer.

In this case-based segment, Dr. Sands presents a patient with EGFR-mutated metastatic non-small cell lung cancer who has progressed after first-line combination therapy with an EGFR tyrosine kinase inhibitor and chemotherapy, now with new brain metastases.

In this segment, Dr. Sands asks Dr. Wakelee how she discusses toxicity profiles and treatment burden with patients when selecting first-line therapy for EGFR-mutated non-small cell lung cancer.

In this case-based segment, Dr. Sands presents a patient scenario involving a 64-year-old never-smoker with EGFR-mutated metastatic non-small cell lung cancer and asymptomatic brain metastases.

In this segment, Dr. Sands asks Dr. Cooper to discuss the role of intracranial efficacy in guiding first-line treatment decisions for EGFR-mutated non-small cell lung cancer.

In this case-based segment, Dr. Sands presents a patient scenario involving a 64-year-old never-smoker with EGFR-mutated metastatic non-small cell lung cancer and asymptomatic brain metastases

In this segment, Dr. Sands asks Dr. Wakelee to discuss the role of value-based frameworks in evaluating first-line treatment options for EGFR-mutated non-small cell lung cancer.

In this segment, Dr. Sands asks Dr. Cooper to discuss the evolving role of TROP2-directed antibody–drug conjugates in EGFR-mutated non-small cell lung cancer. Dr. Cooper explains that these agents are designed to deliver cytotoxic payloads directly to tumor cells by targeting TROP2, a surface antigen expressed in many epithelial cancers, thereby enhancing antitumor activity while attempting to limit off-target effects.

In this segment, Dr. Sands asks the panel to reflect on how emerging data presented at recent meetings, including ELCC, are influencing treatment strategies in EGFR-mutated non-small cell lung cancer.

In this segment, Dr. Sands invites the panel to discuss how subcutaneous administration may influence treatment experience in EGFR-mutated non-small cell lung cancer, referencing data from the PALOMA-3 trial.

In this segment, Dr. Sands leads a discussion on how clinicians approach risk–benefit assessment in EGFR-mutated non-small cell lung cancer as newer combination strategies become available.

In this segment, Dr. Sands invites Dr. Cooper to explain how she evaluates key efficacy outcomes in selecting first-line therapy for EGFR-mutated non-small cell lung cancer, emphasizing the importance of integrating progression-free survival, overall survival, CNS activity, and patient-specific factors to guide individualized, real-world treatment decisions.

In this opening segment, Dr. Sands invites the panel to outline the current treatment landscape for EGFR-mutated non-small cell lung cancer, with Dr. Wakelee and Dr. Cooper highlighting how recent advances, including data from key phase III trials, are shaping first-line decisions, balancing monotherapy and combination strategies, and integrating efficacy, CNS activity, and tolerability into real-world clinical practice.

Oncology care thrives on teamwork, emphasizing patient education and communication to manage treatment-related ocular toxicities effectively.

Explore the differences in supportive care for antibody-drug conjugates and their impact on ocular health in patients.