Gene G. Finley, MD

Gene G. Finley, MD, medical oncologist at Allegheny Clinic Medical Oncology of Allegheny Health Network, discusses how he envisions the treatment landscape of small cell lung cancer may evolve over the next 5-10 years.

, Finely notes that there are a number of trials underway, many of which have already been completed, looking at liquid biopsies to detect tumor-related DNA as it reappears in the blood. Some of these studies have already demonstrated the benefit of liquid biopsies and bespoke assays in this space.

It is also predicted that treating patients in an earlier line will derive more benefit compared with waiting until they have a radiographic relapse, and that newer targeted therapies and antibody drug conjugates in development will be useful.

 In terms of other drugs, when you think about lung cancer generally, non–small cells have become the poster child for targeted therapy. A number of targeted drugs have been attempted in small cell lung cancer and have really fallen flat, as most single-agent chemotherapies have. We also tried using more intensive chemotherapy in the first-line setting and small cell lung cancer, and that was not helpful either.

 I'm hopeful that some of the newer targeted drugs and some of the antibody drug conjugates that are in development will ultimately be useful. I'm hoping that this irinotecan formulation will be helpful.

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Gene G. Finley, MD, discusses how he envisions the treatment landscape of small cell lung cancer may evolve over the next 5-10 years.

Predicting Future Treatment Options for Patients With SCLC

Gene G. Finley, MD, medical oncologist at Allegheny Clinic Medical Oncology of Allegheny Health Network, discusses some of the challenges seen when treating patients with small cell lung cancer (SCLC).

For experts working in the SCLC field, immunotherapy (IO) has sparked interest over recent years. With this, new improvements and treatment options have been brought to the table.

Still, questions remain in SCLC as options are lacking, especially for patients who relapse. Finley attributes this to most of the second-line treatments being unsatisfactory.

 One is, what do you do with the extensive-stage patient, which most of them are, who relapses, because the treatments in the second-line setting are unsatisfactory. Lurbinectedin [Zepzelca] was a bit of an improvement and there's other single-agent chemotherapy, but we haven't had much mileage out of reintroducing immunotherapy, if it's been given in the first-line setting.

 In terms of limited disease, I think we're doing quite well and are looking forward to the time where we will have other drugs to give after chemoradiation. The way it is now, you incorporate the radiation in first-line therapy with platinum-based doublets for topotecan for example. Then after that, it's mainly an observational strategy. Most patients will stay in remission and many end up relapsing. Then, we're looking again at IO or chemotherapy with IO depending on the duration and the length of their admission. I think there's room to introduce immunotherapy or other drugs and in the post-chemotherapy radiation setting. I know that's of interest and people are designing trials in that space.

Gene G. Finley, MD, discusses some of the challenges seen when treating patients with small cell lung cancer.

Pitfalls With Treatment in the SCLC Space

Gene G. Finley, MD, medical oncologist at Allegheny Clinic Medical Oncology of Allegheny Health Network (AHN), discusses the potential use of molecular testing to improve outcomes for patients with relapsed small cell lung cancer (SCLC).

Finley says that while there are not many known actionable biomarkers for SCLC, there is potential in using liquid biopsy to predict the chance of relapse, as is possible for patients with early-stage resected colon cancer. Circulating tumor DNA in the blood is being investigated as a predictor of relapse rather than waiting until radiographic evidence of relapsed disease to begin treatment.

This approach could benefit patients with limited-stage SCLC whose disease has not yet recurred, since SCLC has poor outcomes for patients who relapse. Treatment options for relapsed disease may be more effective if they are begun earlier.

Similar early intervention trials in SCLC would be valuable, according to Finley, and he says AHN is collecting patient biomarker data that could be used to find predictors of better or worse outcomes in SCLC and other cancer types.

There’s not many well-defined biomarkers that are useful in the small cell space, unfortunately. What I do think has some legs is this idea of using a liquid biopsy as a strategy to predict patients [who] are destined for relapse and then providing an intervention there. We know in colorectal cancer, for example, in patients with early-stage resected disease, that you can utilize a liquid biopsy or bespoke assays to detect tumor-related DNA as it reappears in the blood. There are a number of intervention trials that are underway and many that have been completed showing that that does have benefit and that we would expect—most oncologists would have predicted—that treating patients in an earlier setting is going to have more benefit than waiting until they have a radiographic relapse.

 Applying that to the small cell setting and certainly in the limited-stage setting might [help] and I think trials like that would be in order. We have a large biomarker biobanking project related to that across all patients with cancer that we see at AHN, so we're very excited about that approach in terms of early-relapse detection and then introduction of therapeutics at a much earlier stage before you have radiographic relapse.

Gene G. Finley, MD, discusses the potential use of molecular testing to improve outcomes for patients with relapsed small cell lung cancer.

Potential for Early Intervention in Relapsed SCLC Based on Liquid Biopsy

Gene G. Finley, MD, medical oncologist at Allegheny Clinic Medical Oncology of Allegheny Health Network, explains the use of conventional chemotherapy in the small cell lung cancer (SCLC) space and the lack of recent successes.

FDA granted accelerated approval to the anti-cancer agent lurbinectedin

 (Zepzelca) for the treatment of adult patients with metastatic SCLC. The basis of this approval came from the promising overall response rate and duration of response observed with the agent.

However, there has not been as much success in the field since. This is especially true for patients with extensive-stage disease and regarding advancements in the second-line setting.

 In terms of conventional chemotherapy, the big news was the registration of lurbinectedin which was a couple of years ago now. We're using that in the second-line setting. These drugs are better than the older drugs like topotecan, but the myelosuppression is a little bit worse, but we've learned to handle that. I think that's been a significant benefit.

Then, if the patient has been off first-line therapy for a long time, it can reintroduce platinum chemotherapy and can even reintroduce immunotherapy if they've been several months off treatment. I think the challenge that we're having in extensive-stage disease for the patients that have primary resistance, is that they usually respond initially, they'll stay in remission for a while, and then they'll relapse. In the second-line setting, we haven't been very successful.

Gene G. Finley, MD, explains the use of conventional chemotherapy in the small cell lung cancer space.


Gene G. Finley, MD | Authors

Articles

Predicting Future Treatment Options for Patients With SCLC

Pitfalls With Treatment in the SCLC Space

Potential for Early Intervention in Relapsed SCLC Based on Liquid Biopsy

Limited Success Seen in the Second-Line for SCLC