Discussing Treatment Advancements in Extensive Stage SCLC


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Sagun Shrestha, MD, discusses how the addition of atezolizumab and durvalumab to treatment options for patients with extensive stage small cell lung cancer has impacted the field for the better.

Sagun Shrestha, MD, medical director of medical oncology at City of Hope Phoenix, discusses the recent advancements in treatment for patients with extensive-stage small cell lung cancer (SCLC) after several decades of limited options.

Prior to the introduction and approval immune checkpoint inhibitors in this space, chemotherapy made up the standard of care for these patients with the backbone option of platinum and etopside chemotherapy. However, in 2019 and 2020 the FDA approved the use of atezolizumab (Tecentriq) and durvalumab (Imfinizi), respectively, in combination for the treatment of patients with extensive-stage SCLC.

Approval for the use of atezolizumab in this space came from the IMpower133 trial (NCT02763579), which showed a median overall survival of 12.3 months among 201 patients on atezolizumab compared with placebo (HR, 0.70; 95% CI, 0.54-0.91, P = .0069). Moreover, median progression-free survival was 5.2 months vs 4.3 months in the atezolizumab vs placebo arm.

For durvalumab, the phase 3 CASPIAN study (NCT03043872) determined that OS was improved for patients who received the PD-1 inhibitor in addition to chemotherapy at a median of 13 months vs 10.3 months in the placebo arm (HR, 0.73; 95% CI, 0.59-0.91; P = .0047). The safety profile of durvalumab, as with atezolizumab, combined with chemotherapy was manageable and no new safety signals were observed.

Shrestha discusses these developments and how they have brought a new level of excitement to treatment options after years of very limited options for patients.


0:08 | In SCLC, over the last several decades the treatment of choice have been the same with the platinum and the etopside [chemotherapy] backbone. But recently, over the last few years, the main change we have had, and the exciting thing about is adding immune checkpoint inhibitors. One of the main drugs we use is atezolizumab, which is Tecentriq or durvalumab, which is Imfinizi, and that has really given more improvement in OS and decrease in chance of [disease] recurrence. Over time, that has really changed the landscape of how we treat extensive stage SCLC.

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