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Current Strategies in Diagnosis and Classification of Small Cell Lung Cancer
Author(s):
Expert oncologists Laurent Greiller, MD, and Christian Grohé, MD, make introductions and review the current paradigm for small cell lung cancer diagnosis and classification.
Transcript:
Laurent Greiller, MD:Hello and welcome to this OncLive Insights® program titled “Evolving Paradigms in the Small Cell Lung Cancer Treatment Landscape.” I’m Dr Laurent Greiller, from Aix-Marseille University [in France]. I’m joined today by my esteemed colleague and fellow thoracic cancer expert, Dr Grohe, whom I would like to invite to introduce himself.
Christian Grohé, MD: Hello to everybody. My name is Christian Grohé. I’m working in Berlin at Thorax Centre, which is part of the comprehensive cancer Charité Comprehensive Cancer Center [in Germany]. We specialize in both diagnostic algorithms and the treatment of patients with small cell lung cancer in part of all sorts of oncology unit. We are something like a 1-stop shop where you can do everything at the same time. I welcome everybody and thank you for joining us. We are going to discuss a number of recent updates in the treatment of small cell lung cancer that were presented at key conferences last year and this year. We will discuss the data in the context of the guidelines. We have the respective guidelines of the European and American guidelines, the treatment landscape, and its impact in clinical practice. In particular, what we can do in first-line treatment and how we are going to treat patients with refractory disease and data lines. Let’s get started.
Laurent Greiller, MD:We are starting this discussion with a module on the evolving treatment landscape for small cell lung cancer in the frontline setting. Dr Grohe, how does a patient normally present with small cell lung cancer?
Christian Grohé, MD: This is a very good question of understanding why the outcome of all patients very often is so poor. Usually, patients with lung cancer can present with weight loss and fatigue. Some patients have hemoptysis and some have certain kinds of other clinical features like dyspnea. [Patients with] small cell lung cancer are an entity unto themselves. They can have fatigue and weight loss. Very often they present at the very later stage. What’s specific for them is that they can present with so-called paraneoplastic syndromes. Some of them have hypernatremia, low sodium that leads to dizziness or confusion. Some of these patients have other very fascinating features. This particular small cell lung cancer, because it’s neuroendocrine, has a mixture of classical internal medicine problems and sometimes neurologic problems…. How do we define these patients? Is there a difference in terms of [American Joint Committee on Cancer] TNM staging, or is there another way of formatting these patients, such as limited or extensive stage? How are we going to do this?
Laurent Greiller, MD: For historical reasons, there is this old classification for patients with limited or extended stage small cell lung cancer. The limited stage is defined as the tumor being confined in 1 hemothorax and the lymph nodes. In other terms, patients can be eligible for radiation therapy, and all the others are classified as extensive stages. Even if TNM staging is now recommended scientifically, it is all classification with limited stage and extensive stage. It’s the one we are used to every day in routine practice. This is an important aspect for the prognosis of this patient. Of course, patients with limited stage disease have better prognosis compared with patients with extensive stage cell lung cancer. But there are also prognostic factors that we have to take into consideration, such as age, [ECOG] performance status, weight loss, and the comorbidities that are frequent in this population of heavy smokers. We are also looking at biological prognostic parameters that we can have in routine practice such as elevated LDH [lactate dehydrogenase] or low sodium. For example, [there is] the syndrome of inappropriate antidiuretic hormone secretion, which is a paraneoplastic syndrome, as you talked about before.
Christian Grohé, MD: I think this is very important to understand that the classification we do, limited and extensive, is based on our belief or anticipation, which might be prognostic. Some patients these days have had a PET/CT scan. Does that play a role in small cell lung cancer in terms of understanding what is limited or extensive and do we recommend that? Does it play a role in clinical practice?
Laurent Greiller, MD: I think that since we are using PET/CT in the diagnostic work-up for this patient, we are seeing a more extensive stage than before. So the question is, is this classification still relevant today? I’m not sure, but in practice we are often using this one.
Christian Grohé, MD: I think it’s still very important. Particularly because we consider radiotherapy an important part of the treatment options for our patients with limited disease. In terms of factors that influence prognosis, what do you think is the most important feature when we look at these patients to understand the prognostic value?
Laurent Greiller, MD:It’s clear that we have more and more elderly patients and that somehow age is important. Performance status is important, but compared with non-small cell lung cancer, we know that patients with poor performance status can really benefit from chemotherapy. For example, patients [with a performance status of 2], which is not so clear in non–small cell lung cancer without actionable molecular alteration. Comorbidities are very important. As I mentioned before, this is a population of heavy smokers, and these patients have other diseases and lung cancer. They have COPD [chronic obstructive pulmonary disease] and they have heart disease. All of these comorbidities have to be taken into account for the [treatment] of these patients.
Transcript edited for clarity.
