Dr. Borghaei on Second-Line Therapy in SCLC

Hossein Borghaei, DO, chief, Division of Thoracic Medical Oncology, director, Lung Cancer Risk Assessment, associate professor, Department of Hematology/Oncology, Fox Chase Cancer Center, discusses the evolving second-line treatment setting in small cell lung cancer (SCLC).

Researchers hoped that immunotherapy would take over that setting, but recent data suggest otherwise. Two press releases recently noted that neither nivolumab (Opdivo) nor atezolizumab (Tecentriq) improved overall survival. Borghaei says this is interesting because most patients with SCLC are smokers, leading to high tumor mutation burden. There have been hypotheses that immunotherapy should be effective in this disease, but clearly there is something researchers do not yet know about the genomic makeup of SCLC, he says.

Most patients, however, will be treated with an immunotherapy/cisplatin combination in the frontline setting. Therefore, second-line treatment is left with the traditional chemotherapy regimens, such as topotecan. More phase III data are needed to determine a distinct second-line regimen.