Immunotherapy Advances Expand the SCLC Treatment Paradigm: With Chandler Park, MD, and Tejas Patil, MD

In part 2 of this 3-part Oncology Unplugged series, Chandler Park, MD, a genitourinary medical oncologist at Norton Cancer Institute in Louisville, Kentucky, and Tejas Patil, MD, an assistant professor of medical oncology at the University of Colorado School of Medicine in Aurora, discussed the evolving small cell lung cancer (SCLC) treatment paradigm. They examined critical data from recent studies, focusing on the role of prophylactic cranial irradiation (PCI) and the effects of immune checkpoint inhibitors in both limited-stage SCLC (LS-SCLC) and extensive-stage SCLC (ES-SCLC).

Dr Patil provided insights into the ongoing shift away from PCI in favor of MRI surveillance, citing a phase 3 Japanese study (UMIN000001755) that showed no overall survival benefit with PCI vs observation in patients with ES-SCLC, despite demonstrating reduced intracranial recurrence rates with PCI. The conversation also highlighted the phase 3 ADRIATIC trial (NCT03703297), which explored the use of consolidation durvalumab (Imfinzi) after chemoradiotherapy in LS-SCLC and demonstrated a clear overall survival benefit with durvalumab vs placebo.

The discussion then turned to the complexities of managing metastatic relapse in SCLC and the emerging role of bispecific T-cell engagers, particularly in platinum-sensitive and -resistant disease. Dr Patil emphasized the logistical challenges of integrating these novel therapies into clinical practice, especially in rural or community settings. Drs Park and Patil also underscored the need for multidisciplinary collaboration and adaptability in the management of this aggressive cancer type.