Advancements in the Treatment and Management of SCLC: Updates From ASCO 2025 - Episode 8
ASCO 2025: Expert Insights on IMforte Trial Findings and Lurbinectedin in First-Line ES-SCLC Maintenance
Panelists emphasized that while the addition of the new drug to maintenance therapy marks a major advance with improved survival, it also brings increased toxicity that necessitates careful patient selection and shared decision-making—especially considering real-world tolerability, impacts on quality of life, subsequent treatment sequencing, and the unresolved questions around its use in patients with brain metastases, underscoring the need for biomarkers and individualized care in this evolving treatment landscape.
The addition of the new drug in the maintenance setting represents a significant advancement, but it also brings some important considerations for patients and clinicians. While the survival benefits are impressive, the toxicity is notably higher compared to maintenance immunotherapy alone. This means patients will face a more challenging phase of treatment, with additional cytotoxic effects that can impact their quality of life. Therefore, shared decision-making is essential, especially ensuring patients have responded well to initial chemo-immunotherapy before starting maintenance. An important benefit of early use in maintenance is that some patients may not tolerate or even reach second-line therapy if waiting, so introducing the drug earlier may improve overall survival by delivering treatment during this critical window.
Despite these promising results, questions remain about how the findings will translate to broader clinical practice, especially for patients who are older, have more comorbidities, or have less robust health than typical clinical trial participants. The real-world application may reveal new challenges related to tolerability and efficacy. The new maintenance regimen also influences subsequent treatment decisions; for example, patients progressing after this approach may move to targeted therapies that hold significant promise, especially for those with specific molecular markers. This evolving treatment landscape highlights the exciting potential of precision medicine in this disease.
Brain metastases pose a unique challenge in applying these findings. Patients with brain metastases were excluded from the trial, so it remains unclear how well this maintenance strategy works in that population. Some patients tolerate the drug well with long-term benefits, while others experience significant toxicity. Identifying which patients will derive durable benefit remains a key unmet need, with biomarkers likely needed to help guide these decisions. Ultimately, treatment choice will need to be individualized, balancing potential benefits, adverse effects, and patient-specific factors, including the presence or history of brain metastases.
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