Dr Singhi on Identifying Care Gaps and Unmet Needs in Early-Stage Lung Cancer

Eric Kumar Singhi, MD, assistant professor, Department of General Oncology, Department of Thoracic/Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses how oncologists are continuing to identify gaps in care and understand unmet needs in patients with small cell lung cancer (SCLC).

In recent years, Singhi says experts in the SCLC treatment field has gained a deeper understanding of unmet needs that exist for patients with this disease. Despite these advancements, there is still a need for more effective treatment strategies for patients with extensive-stage SCLC (ES-SCLC), Singhi emphasizes. In 2024, the most significant developments in the extensive-stage setting have been in subsequent lines of therapy, particularly with the phase 2 DeLLphi-301 trial (NCT05060016), he explains. Findings from this trial supported the May 2024 FDA approval of tarlatamab-dlle (Imdelltra) for the treatment of patients with ES-SCLC who have disease progression on or after platinum-based chemotherapy. Tarlatamab is a bispecific T-cell engager that binds to DLL3, which is often overexpressed in SCLC cells, as well as CD3 on T cells, enhancing T-cell activity against cancer, Singhi says.

In DeLLphi-301, tarlatamab generated a 40% (95% CI, 31%-51%) objective response rate in patients (n = 99) who had undergone 2 or more lines of prior therapy. This approval represents an important milestone, yet clinical trial enrollment is still recommended in the National Comprehensive Cancer Network Guidelines for patients with SCLC with progressive disease following first-line chemoimmunotherapy, he elucidates.

One key aspect of the DeLLphi-301 study was the per-protocol management of treatment-related toxicities, particularly cytokine release syndrome (CRS), Singhi continues. Fortunately, most cases of CRS were manageable and predictable, typically appearing during cycle 1, according to Singhi. Despite these adverse effects, tarlatamab has the potential to be practice-changing, he emphasizes. However, given the necessary hospital admissions for the first 2doses and the close monitoring requirements, integrating this treatment into routine practice presents logistical challenges, Singhi notes.

Further research is underway to explore tarlatamab’s role in treating patients with limited-stage SCLC, which could extend its benefits to an earlier disease setting, Singhi concludes.