Novel and Emerging Frontline Treatment Strategies in SCLC


Before closing out their first module, expert oncologists consider novel treatment strategies and agents in the frontline setting of stage small cell lung cancer.


Christian Grohé, MD: I think, overall, the combination of adverse events is not too much of a problem. I think that’s what we have seen. It’s more the context, what we have to think about and what’s coming as our next topic now, is just how we proceed from here. If not all patients benefit, it doesn’t make any sense to increase toxicity by using the same kind of chemotherapy or IO [immunotherapy] combination. What do you think, what would be the next step to develop a better outcome in these patients with small cell lung cancer? Still a median overall survival of 12.9 months. That’s still not very good. There’s still a lot of room there to improve outcomes. What would you think would be the next step, how we can just add something to that portfolio, to make the overall outcome of our patients better?

Laurent Greiller, MD:As always, there is a temptation to add a force agent. As we discussed previously, is the addition of tremelimumab, for example. There is also data with ipilimumab. So anti-CTLA-4 inhibitors don’t really add to small cell lung cancer. In terms of immunotherapy, there was also data with anti-TIGIT antibody, but the results are disappointing. I’m not sure that this kind of agent will be helpful for small cell lung cancer patients. There are additional new agents who are currently in development. In terms of chemotherapy, antibody-drug conjugates, and bispecific antibodies. My hope will be directed more on these new drugs than the classical checkpoint inhibitors.

Christian Grohé, MD: You’re already talking about personalized medicine for small cell lung cancer patients. I think this is the future if you have the right biomarkers. You have mentioned that TIGIT didn’t work. I think this is another example [where they] didn’t preselect the patients, so things failed. We have an ongoing trial in Europe or globally, called IMforte [NCT05091567], which is a trial where you have the standard of care 4 cycles, platinum-based chemotherapy, etoposide, and atezolizumab. Then you have a maintenance phase where you add lurbinectedin. There are other trials currently enrolling using other options like PARP inhibitors, or other things, to improve outcome in this cohort. It does make sense that you preselect your patients by clinical means. Once you have made it through 4 cycles, maybe you’re good for maintenance therapy and then you can add something. The patients who fail early, maybe that’s a different kind of biological ballpark. This is something. It’s important to add [to] that portfolio to have new drugs coming up. As you mentioned, the fourth drug, it’s an option to improve maintenance therapy. Saying that to [wrap] up the first module, we need more markers. I think we need more clinical and biological markers to preselect our patient cohort, to show that we have the best treatment for all patients. I think that’s something we really have to learn in small [cell lung cancers]. It’s a very interesting field. What do you think, Laurent, for the first line, what would be the idea you have? What would you like to see as the next thing?

Laurent Greiller, MD: I think our goal is to move in small cell lung cancer as we moved in non–small cell lung cancer, with proper identification of good patients for the good drug. We are far from that today, but I think we are moving forward, and so we have to work on that. It’s very important.

Christian Grohé, MD: I think this is a good summary, thank you very much.

Transcript edited for clarity.

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