The push for more screening of patients with a history of smoking is providing oncologists the ability to catch small cell lung cancers earlier and potentially change the prognosis of the disease.
Sagun Shrestha, MD, medical director of medical oncology at City of Hope Phoenix, discusses how and why better screening practices for patients with a history of smoking can impact their small cell lung cancer (SCLC) diagnosis and the prognosis of the field at large.
With the FDA approvals of atezolizumab (Tecentriq) and durvalumab (Imfinzi) the use of these immune checkpoint inhibitors (ICIs) has shown promise for extending patients survival where there were once limited treatment options. Results from the IMpower133 trial (NCT02763579) showed that first-line atezolizumab, in addition to chemotherapy, benefitted the patients’ overall survival (OS) compared with placebo at a median of 12.3 months vs 10.3 months (HR 0.70; 95% CI, 0.54-0.91, P = 0.007). Further, updated results from the CASPIAN study (NCT03043872) showed an improved median OS of 10.4 months (95% CI, 9.6-12.0) when adding tremelimumab (Imjudo) plus platinum-etoposide to durvalumab. Durvalumab with just platinum-etoposide maintained OS improvement vs chemotherapy alone with a median OS of 12.9 months (95% CI, 11.3-14.7) compared with 10.5 months (95% CI, 9.3-11.2), respectively (HR 0·75; 95% CI, 0.62-0.91, P = 0.0032).
Shrestha hopes that with the increased use of ICIs and looking at their potential to impact efficacy not just for patients with extensive stage SCLC but also those with early-stage SCLC. As the disease is one primarily associated with smokers, Shrestha hopes that continued screening, and continued improvement in screening, can get treatment to these patients earlier. Not only will outcomes change, but hopefully the overall prognosis of the disease as well.
0:08 | Not just with the treatment aspect, but now we are doing a lot of screening for smokers. For people who are chronic smokers, we are doing the low-dose CAT scans, like for [patients with] breast cancer where we do mammograms, that's the standard of care. Now, we are promoting more and more, saying we need to do low-dose CT scans for patients who are chronic smokers. So, we are able to catch them at an earlier stage and that makes a whole lot of difference. I fell over the years, in the next 5 to 10 years, we should be able to diagnose small cell lung cancer earlier in these patients, because it is a disease for smokers.