VIDEO: Treatment options for metastatic small cell lung cancer

Editor’s note: This is an automatically generated transcript, which has been slightly edited for clarity. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

The standard treatment for small cell lung cancer is something that, really, the framework has been established for decades. And then within the last 5 years, we’ve seen the incorporation of immunotherapy — at this point, particularly within the first-line setting.

So standard of care, at this time, is chemotherapy plus immunotherapy in the first-line setting. The huge advancement in this has really been in the tail of those curves. We see a median progression-free survival that’s pretty similar — median overall survival of 2 or more months of benefit. But the really substantial benefit that we see is in the tail of the curves. It’s in the people that — I’ll make the statement that I think there are some individuals that may actually be cured of this incurable diagnosis. And we see that in the tail of the curves and in the patients who are now, at this point, I have people more than 5 years out from the time that they started their treatment with ongoing disease control. And that’s not something we really saw with chemotherapy alone.

So, this is now the standard-of-care first-line therapy. Another advance in the field is now the incorporation of lurbinectedin (Zepzelca; Jazz Pharmaceuticals, PharmaMar) as a second line and beyond treatment option. This is along with the decades-long topotecan really previously being the standard of care for second line. I do use irinotecan instead of topotecan, typically due to the favorable toxicity profile. Paclitaxel is a regimen that I’ll use in the third line or beyond, and temozolomide is really something we’ve had multiple studies that really show some benefit. Unfortunately, it’s not overwhelming, but there really is a good blood-brain barrier penetration and that’s an important one when considering [central nervous system] control.