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Overview of Frontline Treatment Options in Small Cell Lung Cancer
Author(s):
Moving on to discuss the treatment armamentarium in small cell lung cancer, expert oncologists consider current standards for frontline therapy.
Transcript:
Laurent Greiller, MD:So, what are the treatment options today for patients with extensive-stage small cell lung cancer? We can say that for decades platinum-based chemotherapy has been the preferred first-line treatment for these patients. We know that the results of this treatment are not fantastic. But these results are better than the best supportive care, but we know that median overall survival is around 9 to 10 months for these patients. In terms of platinum agents, we know from meta-analysis on individual patient data that there is no difference in terms of overall survival between cisplatin and carboplatin. There are differences in terms of toxicity profile with cisplatin being more toxic with nausea, vomiting, and renal toxicity, while carboplatin is more toxic in hematology. Therefore, in extensive-stage cell lung cancer, cisplatin is often substituted by carboplatin. That's the first point.
After the first-line chemotherapy, several trials tested the maintenance treatment with different drugs. None of these trials showed improved outcomes compared with the standard 4 to 6 cycles of platinum based chemotherapy. So, maintenance treatment with a chemotherapy agent doesn't add anything. Recently, immunotherapy with anti-PD-L1 agents are really modified as a treatment landscape for small cell lung cancer. There were 2 positive randomized phase three trials who are very well known today. First, the IMPOWER133 trial (NCT02763579) assessed the addition of atezolizumab to standard chemotherapy with carboplatin plus etoposide in patients with extensive-stage small cell lung cancer. These patients benefited from the addition of atezolizumab in terms of PFS [progression-free survival] and in terms of OS [overall survival]. It was 2 months again in OS, the median overall survival moved from 10 appointments to 12 appointments. It's statistically significant, but it's also clinically meaningful. The second randomized phase 3 trial, which is well known as a CASPIAN trial (NCT03043872), design was not exactly the same. It was a 3-arm randomized trial with the first standard arm with platinum etoposide, the platinum was cisplatin or carboplatin.
There were 2 experimental arms in this trial. The combination of durvalumab plus chemotherapy or the combination of durvalumab, serplulimab plus chemotherapy, so anti-PD-L1, anti-PD-L4 plus the 2 drugs of chemotherapy. This trial is positive for the addition of durvalumab to chemotherapy with very comparable outcomes compared with IMPOWER133. Other important information is that the addition of serplulimab to durvalumab chemotherapy doesn't translate into improved outcomes. Today, we can say that eligible patients to immunotherapies, as a standard of care today, is a combination of chemo plus and anti-PD-L1 agent is atezolizumab or durvalumab.
Transcript edited for clarity.
