 series, Chandler Park, MD, a genitourinary medical oncologist at Norton Cancer Institute in Louisville, Kentucky, and Tejas Patil, MD, an assistant professor of medical oncology at the University of Colorado School of Medicine in Aurora, discussed the evolving small cell lung cancer treatment paradigm. They also examined critical data that were presented at the 2024 ASCO Annual Meeting, focusing on treatment developments for patients with 

-positive non–small cell lung cancer (NSCLC).

Dr Patil emphasized the significance of the phase 3 CROWN trial (NCT03052608), which compared lorlatinib (Lorbrena) with crizotinib (Xalkori) in patients with 

-positive metastatic NSCLC. With a hazard ratio of 0.19 (95% CI, 0.13-0.27) for progression-free survival, the trial demonstrated lorlatinib’s superior intracranial control and long-term efficacy compared with crizotinib, especially in patients with brain metastases. Drs Park and Patil also discussed challenges associated with managing lorlatinib-related toxicities, including mood changes, weight gain, and hyperlipidemia. Dr Patil suggested that starting at a lower dose and gradually escalating to the recommended dose could help mitigate some of these adverse effects and simultaneously maintain treatment efficacy.

The conversation concluded with a shift towards the broader application of targeted therapies in earlier disease stages, drawing parallels between the phase 3 ALINA study (NCT03456076) in patients with 

-positive NSCLC and the phase 3 ADAURA study (NCT02511106) in patients with 

-mutated NSCLC. Dr Patil expressed interest in the future role of minimal residual disease (MRD) monitoring in these settings, suggesting that earlier interventions based on MRD status could help delay relapse and improve long-term outcomes for patients receiving TKIs.

Podcasts

Drs Park and Patil delve into the evolving SCLC treatment paradigm by examining data from recent studies and focus on treatment developments for patients with ALK-positive NSCLC.

How to Apply Research Developments in ALK-Positive NSCLC: With Chandler Park, MD, and Tejas Patil, MD

 series, Chandler Park, MD, a genitourinary medical oncologist at Norton Cancer Institute in Louisville, Kentucky, and Tejas Patil, MD, an assistant professor of medical oncology at the University of Colorado School of Medicine in Aurora, discussed the evolving small cell lung cancer (SCLC) treatment paradigm. They examined critical data from recent studies, focusing on the role of prophylactic cranial irradiation (PCI) and the effects of immune checkpoint inhibitors in both limited-stage SCLC (LS-SCLC) and extensive-stage SCLC (ES-SCLC).

Dr Patil provided insights into the ongoing shift away from PCI in favor of MRI surveillance, citing a phase 3 Japanese study (UMIN000001755) that showed no overall survival benefit with PCI vs observation in patients with ES-SCLC, despite demonstrating reduced intracranial recurrence rates with PCI. The conversation also highlighted the phase 3 ADRIATIC trial (NCT03703297), which explored the use of consolidation durvalumab (Imfinzi) after chemoradiotherapy in LS-SCLC and demonstrated a clear overall survival benefit with durvalumab vs placebo.

The discussion then turned to the complexities of managing metastatic relapse in SCLC and the emerging role of bispecific T-cell engagers, particularly in platinum-sensitive and -resistant disease. Dr Patil emphasized the logistical challenges of integrating these novel therapies into clinical practice, especially in rural or community settings. Drs Park and Patil also underscored the need for multidisciplinary collaboration and adaptability in the management of this aggressive cancer type.

Drs Park and Patil discuss the evolving small cell lung cancer treatment paradigm, focusing on PCI, immune checkpoint inhibitors, and recent study data.

Immunotherapy Advances Expand the SCLC Treatment Paradigm: With Chandler Park, MD, and Tejas Patil, MD

In Oncology Unplugged, a podcast series from MedNews Week, host Chandler Park, MD, a genitourinary medical oncologist at the Norton Cancer Institute in Louisville, Kentucky, sits down with Tejas Patil, MD, an assistant professor of medicine-medical oncology at the University of Colorado School of Medicine - Anschutz Medical Campus in Aurora.

In this episode, Drs Park and Patil discuss key updates from the 2024 ASCO Annual Meeting, including the significance of data from the phase 3 LAURA trial (NCT03521154), where treatment with osimertinib (Tagrisso) following definitive chemoradiotherapy led to an improvement in progression-free survival vs placebo in patients with stage III, 

-mutated non–small cell lung cancer (NSCLC).

Drs Park and Patil also explore the implications of minimal residual disease (MRD) monitoring in the phase 3 ADAURA trial (NCT02511106) and how liquid biopsy data may influence future treatment timelines. Additionally, they delve into the evolving role of osimertinib in advanced 

-mutated NSCLC, based on results from the phase 3 FLAURA2 trial (NCT04035486) and its potential impact on the treatment of patients with brain metastases.

In this episode, Drs Park and Patil discuss key updates from the 2024 ASCO Annual Meeting, including the significance of data from the phase 3 LAURA trial.

Tejas Patil, MD

Articles

How to Apply Research Developments in ALK-Positive NSCLC: With Chandler Park, MD, and Tejas Patil, MD

Immunotherapy Advances Expand the SCLC Treatment Paradigm: With Chandler Park, MD, and Tejas Patil, MD

Park and Patil Explore Advances in EGFR + NSCLC From ASCO 2024