Dr. Hirsch on Diagnosing and Managing Metastatic SCLC

Fred R. Hirsch, MD, PhD, executive director, Center for Thoracic Oncology, The Tisch Cancer Institute at Mount Sinai; Joe Lowe and Louis Price Professor of Medicine, Icahn School of Medicine at Mount Sinai, discusses the rarity of diagnosing patients with small cell lung cancer (SCLC) early in the disease course, unmet needs in SCLC screening, the importance of ECOG performance score (PS) when considering patients for clinical trials, and factors influencing hospice care decisions in patients with SCLC.

Dr. Hirsch on Early SCLC Diagnosis and Management

In rare cases, SCLC can be diagnosed in early, localized stages, including T1, T2, node-negative, or nonmetastatic stages, Hirsch says. For these patients, lobectomy is a potentially effective option for managing the disease, Hirsch notes. However, most cases of SCLC present at locoregional or extensive disease stages at diagnosis, at which point surgery is no longer an option, Hirsch says. More research is necessary to discover more sensitive SCLC screening methods and determine best practices for diagnosing this disease, so more patients can be diagnosed earlier in their disease course and receive surgery, Hirsch concludes.

Dr. Hirsch on Hospice Care in SCLC

Hospice care should be considered the last stage of treatment for patients with SCLC and is often an option for patients who have exhausted all recommended therapies, such as topotecan and lurbinectedin (Zepzelca), and have a poor ECOG PS, Hirsch says. Fortunately, many ongoing clinical trials in SCLC could provide therapeutic alternatives to hospice for patients who enroll. However, a low PS is often a key eligibility requirement for participation in these trials, Hirsch emphasizes. If patients have a PS of 2 or higher and have progressed on the standards of care in the first and second lines, hospice care, after communication with the patients and their families, can be an option, Hirsch explains.