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Ramalingam Weaves Through Expanding SCLC Landscape

Angelica Welch
Published: Wednesday, May 23, 2018

Suresh S. Ramalingam, MD

Suresh S. Ramalingam, MD
The treatment of patients with small cell lung cancer (SCLC) has changed very little in the last few decades. However, the introduction of checkpoint inhibitors may change the prognosis for a number of patients with this disease, said Suresh S. Ramalingam, MD.

, Ramalingam, deputy director of Winship Cancer Institute of Emory University, shed light on the recent data with these agents in SCLC.

OncLive: What is the prognosis of patients with newly diagnosed SCLC?

Ramalingam: We divide SCLC into 2 broad subgroups. There is what we call limited-stage SCLC, which is an earlier stage of lung cancer, and then there is extensive-stage SCLC, which is the typical metastatic SCLC. The prognosis is different for these 2 groups. If someone has limited-stage SCLC, we see a 5-year survival rate of approximately 25%. There is a subset of those patients whom we can cure with chemotherapy and radiation. We cannot cure patients with extensive-stage disease. Presently, the median survival is around 10 months. Their prognosis is considerably worse than those with limited stage SCLC. 

The FDA recently granted a priority review to single-agent nivolumab for the treatment of patients with SCLC. Could you share some insight on the efficacy of this agent in this disease?

PD-1/PD-L1 inhibition seems to be a rational strategy in SCLC. These tumors have a high TMB, which can predict who might benefit from agents like nivolumab and pembrolizumab. There will be some phase II studies done with nivolumab and pembrolizumab. [These agents] have shown response rates of 10% to 15%. These are used in patients who have already had standard chemotherapy in the frontline setting, and then go on to get immunotherapy in the second-line setting. The median progression-free survival is relatively modest with the immune checkpoint inhibitors. At first look, one could say that there is some promise here, but we need to better understand who responds to these agents and how we can personalize therapy based on biomarkers. 
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