Dr Chiang on Frontline Treatment Combinations in ES-SCLC

Anne Chiang, MD, PhD, associate professor, medicine, Section of Medical Oncology, associate director, Yale Cancer Center, discusses treatment options for patients with extensive-stage small cell lung cancer (ES-SCLC).

Two frontline combinations of immunotherapy plus chemotherapy are available for patients with ES-SCLC: atezolizumab (Tecentriq) plus chemotherapy and durvalumab (Imfinzi) plus chemotherapy, Chiang says. Both combinations provide durable responses in this population, Chiang notes.

The phase 3 CASPIAN trial (NCT03043872) investigated the safety and efficacy of first-line durvalumab plus the chemotherapy regimen etoposide and carboplatin or cisplatin, durvalumab plus tremelimumab (Imjudo) and chemotherapy, or chemotherapy alone in patients with ES-SCLC, and served as the pivotal trial for the 2020 FDA approval of durvalumab plus chemotherapy in the frontline setting in this population. With 25.1 months of median follow-up, durvalumab plus tremelimumab and chemotherapy did not generate a significant overall survival (OS) improvement vs chemotherapy alone, with a median OS of 10.4 months vs 10.5 months, respectively. At a median follow-up of 39.4 months, the median OS was 12.9 months in patients who received durvalumab plus chemotherapy vs 10.5 months in those who received chemotherapy alone. In addition, the 3-year OS rates were 17.6% vs 5.8% in the durvalumab and chemotherapy arms, respectively.

The phase 3 IMpower133 trial (NCT02763579) evaluated the safety and efficacy of the combination of atezolizumab plus carboplatin and etoposide vs placebo plus carboplatin and etoposide in patients with previously untreated ES-SCLC. Findings from this trial supported the 2019 FDA approval of atezolizumab plus chemotherapy in this population. At a median follow-up of 22.9 months, the median OS was 12.3 months in the atezolizumab arm vs 10.3 months in the placebo arm. In addition, the 18-month OS rates were 34.0% and 21.0% in the atezolizumab and placebo arms, respectively.

Further research may extend the benefits of these combination regimens to more patients with SCLC, Chiang concludes.