Dr Massarelli on Addressing Unmet Needs in SCLC

Erminia Massarelli, MD, PhD, MS, co-director, Lung Cancer and Thoracic Oncology Program, associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses unmet needs in the treatment of patients with small cell lung cancer (SCLC) that were discussed at the 2023 Bridging the Gaps in Lung Cancer meeting, as well as how further research may help mitigate these needs.

One gap in care hindering advances in SCLC treatment is the lack of individually tailored research and therapies for the 2 main types of SCLC: SCLC in former or current smokers, and SCLC in never-smokers. The latter subtype usually arises as a transformation from a molecularly driven disease, such as EGFR-mutated non–small cell lung cancer, Massarelli says. These 2 categories of SCLC differ from each other, and thus require different testing and treatment considerations, Massarelli notes. Molecular testing is crucial in never-smokers with transformed SCLC, as it can reveal targetable drivers of disease, Massarelli emphasizes. Although molecular testing may also be useful in patients with smoker-driven SCLC, the advantages of identifying molecular drivers and potential targeted treatment options in this patient subset remain unclear, Massarelli explains.

Another important gap in the management of patients with SCLC is the lack of effective therapies in this population, according to Massarelli. The progress in this area over the past 30 years has been minimal, Massarelli says. One of the most recent FDA approvals of an immunotherapy for patients with SCLC was the 2019 accelerated approval of pembrolizumab (Keytruda) monotherapy in patients with metastatic disease who had progressed on at least 2 prior lines of therapy, including 1 line of platinum-based chemotherapy. Several clinical trials led by academic institutions and pharmaceutical companies are ongoing to address the need for more SCLC treatment options, Massarelli notes. Patients with SCLC are encouraged to participate in these trials, which may lead to the discovery of novel targets and treatments, Massarelli concludes.