Dr Mohindra on Updates in SCLC Management

Nisha A. Mohindra, MD, thoracic oncologist, Robert H. Lurie Comprehensive Cancer Center, associate professor of medicine, Division of Hematology Oncology, Surgery, Northwestern University Feinberg School of Medicine, discusses key updates to practice guidelines for the management of small cell lung cancer (SCLC).

At the time of recurrence, determining the appropriate treatment strategy has been a significant challenge for clinicians, Mohindra begins. In 2024, the National Comprehensive Cancer Network (NCCN) released updated clinical practice guidelines for SCLC, Yaeger continues. Version 2.2024 of the guidelines has provided more detailed considerations for SCLC management, including the assessment of chemotherapy-free intervals and provided insights on selecting regimens based on clinically observed benefits, Mohindra details.

One notable advancement in SCLC is the availability of long-term data from the first-line setting, particularly for patients eligible for immunotherapy up front in combination with chemotherapy, Mohindra continuess. Moreover, 5-year survival rates observed with these regimens have confirmed their efficacy and support their continued utility in eligible patients, she adds.

However, there remain several challenges and in the second-line setting and beyond, Mohindra statess. These challenges allow for ongoing research opportunities within the space. Continued investigations and data collection in this arena are essential to further refine treatment strategies and improve outcomes for patients experiencing recurrence, Mohindra says. As more data becomes available, additional elements can be incorporated into treatment decision making, Mohindra concludes.

There are currently 2 agents approved by the FDA for use in the second-line setting in SCLC: topotecan and lurbinectedin (Zepzelca), which gained approval in 2020 for the treatment of adult patients with disease progression following platinum-based chemotherapy. However, it's important to acknowledge that there are other agents showing efficacy in clinical studies, even if they don't yet have official approval, Mohindra stresses. When considering treatment options for a patient experiencing recurrence, several factors come into play, including the presence or absence of brain metastases, the patient's performance status, and the available treatment guidelines.

Although these approvals and guideline recommendations provide important frameworks for treatment decisions, they may not encompass all available options or fully capture individual patient factors, Mohindra adds. The broader landscape of clinical evidence and emerging therapies should therefore be considered when determining the most appropriate treatment approach for each patient, she concludes.