Dr Das on Updated Data Supporting the Use of Chemoimmunotherapy Regimens in ES-SCLC

Devika Das, MD, MSHQS, clinical assistant professor of hematology and oncology, University of Alabama at Birmingham (UAB) Medicine, discusses updated data on the use of immunotherapy and platinum-based chemotherapy regimens in extensive-stage small cell lung cancer (ES-SCLC).

Research into SCLC treatment fell short in the attempt to improve historicaloutcomes in ES-SCLC, Das begins. Despite attempts to modify standard treatment approaches in non–small cell lung cancer, carboplatin and etoposide combinations remained the standard of care (SOC) in this space for decades. However, the addition of immune checkpoint inhibitors to the treatment landscape has impacted frontline approaches.

In 2019, the FDA approved atezolizumab (Tecentriq) for the first-line treatment of ES-SCLC in combination with etoposide and either carboplatin or cisplatin based on data from the phase 3 IMpower-133 trial (NCT02763579), Das reports. In this trial, the atezolizumab regimen produced a 12-month overall survival (OS) rate of 51.7% (n =201) vs 38.2% with placebo (n =202).

Then, in 2020, first-line treatment with durvalumab (Imfinzi) plus platinum/etoposide gained FDA approval in this space, according to findings from the phase 3 CASPIAN trial (NCT03043872), Das adds. The 12-month OS rates were 52.8% in the durvalumab arm (n = 268) vs 39.3% in the platinum/etoposide arm (n = 269).

Updated survival data from the CASPIAN trial were reported in 2022, Das continues. The 3-year OS rate was 17.6% in patients who received the durvalumab regimen compared with 5.8% in patients who received platinum doublet chemotherapy, Das states. These results confirmed the use of durvalumab plus platinum/etoposide as a first-line SOC for ES-SCLC.

Despite these encouraging results, there are currently no biomarkers available to predict patient response and guide treatment selection in this population, creating an unmet need, Das notes. Ongoing clinical trials are attempting to address this deficit, she concludes.