Benjamin P. Levy, MD
The reach of immunotherapy has extended into small cell lung cancer (SCLC), waking up a treatment landscape that had become somewhat dormant. Despite these advances, however, investigators are still struggling with this patient population, said Benjamin P. Levy, MD.
, Levy, an assistant professor of oncology and the clinical director of Medical Oncology at Sidney Kimmel Cancer Center and Johns Hopkins Medicine, discussed the rise of checkpoint inhibitors in SCLC, an emerging targeted agent in non–small cell lung cancer (NSCLC), and the road that lies ahead in the overall landscape.
OncLive: What is your perspective on the FDA approval of atezolizumab plus carboplatin and etoposide in SCLC?
: For many years, we have been looking for novel therapies to improve outcomes for patients with SCLC, an unforgiving disease. Time after time, we have seen that the drugs we tried have just failed to work. Things have changed, of course, with IMpower133. This was a trial looking at the combination of atezolizumab with carboplatin and etoposide versus carboplatin and etoposide alone in patients with extensive-stage SCLC. There were more than 400 patients enrolled in this study and they were randomized 1:1. The bottom line is that when atezolizumab was added to carboplatin/etoposide and continued as maintenance, there was a benefit not only in PFS, but also in OS. There was roughly a 2-month improvement in OS, with a hazard ratio of 0.7. These are numbers that have really been unheard of in SCLC.
However, what we have found in this trial, as we have found in NSCLC, is that the toxicity is not prohibitive. Generally, the 3-drug regimen is well tolerated. This is a welcome change for doctors and oncologists, but more importantly, for patients.
Pembrolizumab has also received a priority review designation by the FDA. What are some ongoing trials that are evaluating this agent in SCLC?
We are on waiting on these data. It The [ongoing KEYNOTE-604] trial has a very similar design [to IMpower133]: adding pembrolizumab to carboplatin and etoposide versus carboplatin and etoposide alone in extensive-stage disease. We will have to see how these data shake out.
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