Dr Singhi on the Potential Benefit of the ADRIATIC Study Findings in LS-SCLC

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 unmet needs in the treatment of patients with small cell lung cancer (SCLC), highlighting how the phase 3 ADRIATIC study (NCT03703297) addressed these needs.

There have been several exciting updates in the management of SCLC, leading to significant improvements in patient care, Singhi begins. SCLC is known for its aggressive nature, with approximately two-thirds of patients presenting with extensive-stage disease at diagnosis and one-third of patients presenting with limited-stage disease confined to 1 side of the chest, he explains. For limited-stage SCLC (LS-SCLC), the standard of care has remained largely unchanged for nearly 4 decades, Singhi reports, adding that this treatment is challenging, requiring several weeks of therapy. Even after successful treatment, 5-year overall survival (OS) rates are still between 15% and 25%, indicating that most patients are not cured, he notes.

Improving clinical outcomes for patients with LS-SCLC has been challenging, Singhi expands. At the 2024 ASCO Annual Meeting, the ADRIATIC study results were presented, he says. The study investigated durvalumab (Imfinzi) as consolidation treatment following concurrent chemoradiation for up to 2 years in patients with LS-SCLC. At a median follow-up of 37.2 months (range, 0.1-60.9), the findings were promising, showing a significant increase in OS with durvalumab (n = 264). The median OS extended from 33.4 months (95% CI, 25.5-39.9) with placebo (n = 266) to 55.9 months (95% CI, 37.3-not evaluable) with durvalumab.

When evaluating new treatments, toxicity is a critical concern, particularly with the combination of radiation and immunotherapy, Singhi expands. A key issue is pneumonitis, an inflammation of the lungs, according to Singhi. However, the ADRIATIC study showed that rates of grade 3 and 4 pneumonitis were only slightly higher with durvalumab compared with placebo, which is reassuring, he emphasizes. After a long period without significant advancements, it is encouraging to see progress in treatment for patients with LS-SCLC, Singhi concludes.