Dr Das on Updates to the Standard First-Line Treatment Paradigm for ES-SCLC

“After many decades of trying novel therapies in combination with platinum and etoposide, [durvalumab] was the drug that led to [an] approval and led to a survival benefit in patients with this difficult-to-treat disease.”

Millie Das, MD, a clinical professor of medicine – oncology in the Department of Medicine at Stanford University; a member of the Stanford Cancer Institute; and chief of Oncology at the VA Palo Alto Health Care System, discussed standard-of-care treatment options for patients with previously untreated extensive-stage small cell lung cancer (ES-SCLC) and limited-stage SCLC (LS-SCLC).

For patients diagnosed with ES-SCLC, the current standard first-line treatment approach includes the addition of a PD-L1 inhibitor to the chemotherapy regimen of platinum plus etoposide, Das began. This strategy is supported by data from randomized phase 3 IMpower133 (NCT02763579) and CASPIAN (NCT03043872) studies. Based on these results, atezolizumab (Tecentriq) and durvalumab (Imfinzi), respectively, have received FDA approval for use in combination with chemotherapy in the initial treatment of patients with extensive-stage disease. This development represents a significant advancement in the management of SCLC, as prior attempts to improve outcomes by combining various investigational agents with platinum and etoposide had not demonstrated a survival benefit, according to Das. The incorporation of immune checkpoint inhibitors has now established a new therapeutic standard in this setting, offering improved survival outcomes for a patient population historically associated with poor prognoses, she highlighted.

In patients with LS-SCLC, recent evidence supports the use of consolidation immunotherapy following completion of chemoradiation, Das said. The phase 3 ADRIATIC trial (NCT03703297), data from which were presented at the 2024 ASCO Annual Meeting, investigated the role of durvalumab in this context. In this study, patients with limited-stage disease who had not experienced disease progression after definitive chemoradiation were randomly assigned to receive either durvalumab or placebo for up to 2 years. The trial demonstrated statistically significant improvements in both overall survival and progression-free survival for patients treated with durvalumab. Based on these findings, durvalumab was FDA approved for use in the consolidation LS-SCLC setting in December 2024. The agent is now routinely offered to patients with LS-SCLC who have completed chemoradiotherapy and remain without disease progression, Das concluded.