Finally, A Step Forward For Small Cell Lung Cancer
- Traditionally, treatment for small cell lung cancer (SCLC) has consisted of chemotherapy followed by immunotherapy alone. However, the IMforte study introduces lignin, a chemotherapy drug, alongside the checkpoint inhibitor cancer drug atezolizumab after the patient’s initial treatment.
- Early data in the IMforte study suggest that adding the chemo drug lignin and atezolizumab combination to a lung cancer patient’s treatment adds about three months of progression-free survival — meaning the period of time the cancer does not worsen — a meaningful step forward.
- Another promising treatment giving SCLC patients another option than chemotherapy is tarlatamab-dll (brand name: Imedlltra). This drug treatment is an immunotherapy that connects immune cells directly to cancerous tumor cells, triggering their destruction.
- Historically, SCLC patients faced poor survival odds with chemotherapy alone, typically living only six to nine months after treatment. Imedlltra, however, has demonstrated a median survival of over a year (13.6 months).
Long dominated by chemotherapy, treatment for this aggressive disease is undergoing a major transformation with groundbreaking advancements that promise improved survival and fewer debilitating side effects — one of the most promising new developments is the use of a drug known as tarlatamab-dll (brand name: Imdelltra).
Read MoreHistorically, SCLC patients faced poor survival odds with chemotherapy alone, typically living only six to nine months after treatment. Tarlatamab, however, has demonstrated a median survival of over a year (13.6 months), offering newfound hope for long-term survivors.
“We’ll continue to track patients over the years, but it’s clear that this therapy is creating a meaningful shift in outcomes,” said Dr. Rudin.
Beyond improving survival rates, newer therapies are also reducing chemotherapy-related toxicity. Traditional treatments often cause chronic fatigue, nausea, and infections, severely impacting a patient’s quality of life.
“These newer therapies not only extend survival but allow patients to return to their lives with fewer side effects,” Dr. Rudin noted.
Even more promising: tarlatamab initially required inpatient hospitalization for the first two doses, but ongoing clinical trials suggest it can now be safely administered in an outpatient setting. Patients who have been on the drug for more than a year report maintaining active lifestyles and receiving biweekly infusions while continuing their everyday routines.
The Promise Of T-Cell Therapies
Another major advancement is T-cell engagers, a novel class of drugs designed to precisely target cancer cells. These treatments avoid many of the toxicities commonly associated with traditional immunotherapies, such as gastrointestinal issues and thyroid dysfunction.
“Unlike other immunotherapies that cause broad side effects, these T-cell therapies activate immune cells in a cancer-specific way, minimizing harm to healthy tissues,” Dr. Rudin explained.
The growing use of antibody-drug conjugates, or “smart bombs,” is also changing cancer treatment. These specialized antibodies deliver chemotherapy directly to tumor cells, reducing damage to surrounding tissues and limiting adverse effects.
Perhaps most importantly, clinical trials for these innovative treatments have expanded eligibility to include patients with brain metastases—individuals previously excluded from groundbreaking therapies.
“Unfortunately, lung cancer often spreads to the brain, and these patients were traditionally left out of key research. This shift ensures more people can access cutting-edge options,” Dr. Rudin said.
With these advancements, researchers are ushering in a new era of lung cancer treatment that prioritizes more prolonged survival, fewer side effects, and improved quality of life.
Emerging Therapies Show Promise in Survival And Quality Of Life
Dr. Laura Alder, a thoracic medical oncologist at Duke University, highlighted the IMforte clinical trial, which explores a more effective approach to maintenance therapy for SCLC patients.
The IMforte trial examined the impact of adding lurbinectedin (brand name: Zepzelca) — a treatment for metastatic small cell lung cancer (SCLC) that has progressed after platinum-based chemotherapy — to standard treatment for extensive-stage small cell lung cancer (ES-SCLC).
The study enrolled 660 patients who had not previously received treatment, had no history of brain or spinal cord metastases, and were in good overall health. All participants underwent standard therapy consisting of four cycles of atezolizumab (a monoclonal antibody used to treat various types of cancer by boosting the immune system’s ability to attack cancer cells), carboplatin (a type of chemotherapy), and etoposide (a type of chemotherapy).
Traditionally, treatment for SCLC has consisted of chemotherapy followed by immunotherapy alone. However, the IMforte study introduces lignin, a chemotherapy drug, into the maintenance phase alongside the checkpoint inhibitor atezolizumab. The goal is to extend progression-free survival (PFS) and improve response duration. Early data suggests this new combination adds about three months of PFS, marking a meaningful step forward.
RELATED: What Do Checkpoint Inhibitors Do For Cancer?
“This is huge because we haven’t seen many updates historically in small-cell lung cancer,” Dr. Alder explained.
“We want to do everything we can to increase progression-free and overall survival, but we also have to carefully weigh the benefits against potential toxicities,” Dr. Alder added.
Beyond treatment advancements, Alder emphasized the critical role of biomarker testing, especially for non-small cell lung cancer (NSCLC) patients.
WATCH: Biomarker testing offers a path to better outcomes for patients.
Comprehensive biomarker testing checks the lung tumor for gene mutations that might respond to targeted therapy.
Genetic testing of the lung tumor is typical for people with stage 4, non-small cell lung cancer. However, biomarker testing is becoming increasingly common for patients with lung cancer at any stage.
“Biomarker testing has revolutionized lung cancer treatment,” Dr. Alder said.
Though biomarker testing isn’t routinely performed for SCLC, certain cases—such as never-smokers or large-cell neuroendocrine lung cancer patients—may benefit from genomic analysis. Meanwhile, NSCLC patients increasingly receive personalized, targeted therapies, which offer better tolerability and precision than standard treatments.
Targeted therapy is a type of treatment that works by identifying specific markers on tumor cells. These markers allow doctors to target specific cancers with drugs or other treatments designed to attack them. By doing so, they can reduce side effects while increasing efficacy and improving survival rates.
WATCH: Immunotherapy and Targeted Therapy for Lung Cancer
Finding Hope In Treatment Advancements
“About half of lung cancer patients will experience their cancer spreading to the brain at some point in their disease course,” Dr. Alder explained. “It’s a difficult diagnosis, often requiring radiation and systemic treatments.”
Ongoing clinical trials now incorporate lung cancer patients with brain involvement, a crucial step toward developing more effective treatment sequencing strategies. Researchers are working to determine the best timing for radiation and systemic therapies while also exploring ways to prevent metastases from recurring.
With these advancements, experts are hopeful that the future of lung cancer treatment will provide longer survival, better quality of life, and fewer side effects for patients.
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