Advanced Lung Cancer: A Year in Review - Episode 19

Limited-Stage SCLC: Is Immunotherapy an Option?


Naiyer Rizvi, MD: Tim, do you think there’s going to be a role for immunotherapy in limited stage disease?

Tim Kruser, MD: That’s currently under investigation with NRGLU0005, led by Kristin Higgins, looking at the incorporation of atezolizumab into the upfront treatment package. I believe there is also another study, ADRIATIC, which is taking more of the PACIFIC [NCT02125461] approach, looking at post-chemo RT [radiotherapy] incorporation of durvalumab. These are rational ways to try to incorporate immunotherapy, given the activity we’ve seen in extensive stage. Additionally, we know that radiation synergizes with immunotherapy. I would harken back to the extensive stage discussion and plug continued usage of thoracic consolidated radiation for extensive stage patients. We heard Jacob talk about the tail end of the curve. In the Slotman study that looked at thoracic radiation and moved the 2-year overall survival from 3% to 13%, with 0 increase in grade 3 toxicity. So the usage of immunotherapy in extensive stage disease, we know it’s safe to use 30 Gy of thoracic radiation with immunotherapy. I don’t see why CASPIAN or IMpower133 preclude the thoughtful utilization of thoracic consolidated radiation, which we know is safe and beneficial, and I hope that rational and biologic synergism also extends into limited stage. We hope it will over time.

Naiyer Rizvi, MD: Leora, would you use consolidation radiation in your extensive stage patients with I/O [immuno-oncology]?

Leora Horn, MD, MSc: Yeah. We do send those patients, particularly the ones with bulky disease upfront, to radiation oncology to have that discussion about consolidation radiation. I agree with Tim that it’s very safe to give. You know, if you’re going to get more Abscopal effect by doing radiation when they’re on their checkpoint inhibitor—I have had several patients who have had their consolidation radiation, and they’re continuing on their atezolizumab, and doing really well at this time. And I have not seen increased toxicities from the consolidation.

Transcript Edited for Clarity