Hung Trinh, Senior VP of Operations at Seneca Therapeutics, shared a post on LinkedIn about a recent article by Roya Behrouzi et. al, published in Therapeutic Advances in Medical Oncology:
“State of the art in treatment of small cell lung cancer!
The addition of immune checkpoint inhibitors (ICIs) to first-line chemotherapy for ES-SCLC has resulted in modest improvements in survival. For limited-stage SCLC (LS-SCLC) treated with radical chemo-radiotherapy, the ICI durvalumab is now approved as a consolidation therapy to reduce relapse risk.
Further trials are investigating ICIs concurrently with chemo-radiotherapy and/or as consolidation or maintenance therapy. For relapsed SCLC, treatment options include chemotherapies such as topotecan or lurbinectedin and carboplatin/etoposide rechallenge.
The delta-like ligand 3-targeting bispecific T-cell engager (BiTE), tarlatamab, has been approved by the FDA for ES-SCLC with disease progression on or after platinum-based chemotherapy and is being evaluated in earlier lines of treatment. Other BiTEs are also in early-phase development, with promising early activity.
Several antibody-drug conjugates, including sacituzumab govitecan, are being tested in clinical trials and have demonstrated encouraging efficacy. Novel targeted therapies aimed at overcoming resistance to chemotherapy and immunotherapy are also in preclinical development.
Despite these advancements, progress remains hindered by the absence of validated biomarkers for predicting treatment outcomes. The identification of SCLC transcriptional subtypes with distinct therapeutic vulnerabilities offers hope for better treatment stratification.
The SCLC-I transcriptional subtype, tumour mutational burden and tumour immune cell signatures are promising biomarkers for longer-term survival benefit from ICIs.
Here are some key FDA-Approved Therapies for SCLC:
For Extensive-Stage SCLC (First-Line/Maintenance):
- Atezolizumab (Tecentriq): Approved with chemotherapy for first-line treatment.
- Lurbinectedin (Zepzelca) + Atezolizumab: Approved for maintenance after initial treatment for those who haven’t progressed.
- Durvalumab (Imfinzi): Approved with chemotherapy and radiation for limited-stage SCLC.
For Extensive-Stage SCLC (After Progression):
- Tarlatamab (Imdelltra): An antibody-drug conjugate (ADC) granted accelerated approval for ES-SCLC that progressed on or after platinum chemo.
- Lurbinectedin (Zepzelca): Approved for metastatic SCLC that has progressed after platinum-based chemo.
- Pembrolizumab (Keytruda): Approved for metastatic SCLC.
- Nivolumab (Opdivo): Also used in SCLC treatment.
Recent Developments:
- Tarlatamab represents a new class (ADC) offering hope for patients whose cancer has progressed.
- The approval of Lurbinectedin + Atezolizumab as first-line maintenance is a significant shift, aiming to extend the time patients stay on treatment before relapse.”
Title: State of the art in treatment of small cell lung cancer
Authors: Roya Behrouzi, Fiona Blackhall
You can read the full article in Therapeutic Advances in Medical Oncology.
More posts from Hung Trinh.