Dr. Mansfield on the Current Treatment Paradigm in SCLC

Aaron S. Mansfield, MD, associate professor of oncology, consultant in the Division of Medical Oncology, Mayo Clinic, discusses the current treatment paradigm for patients with extensive-stage small cell lung cancer (SCLC) and highlights ongoing research in the field.

For decades, the standard of care has been a platinum doublet, either cisplatin or carboplatin with etoposide. However, progress has not moved much beyond that, explains Mansfield. Although these regimens are fairly effective in terms of tumor shrinkage, the responses have not been durable. After initial response, the tumor tends to progress quickly thereafter. Patients with a diagnosis of SCLC have poor survival, averages of which have yet to surpass 1 year.

However, there are several ongoing trials in which investigators are examining different therapeutic approaches. At the 2019 AACR Annual Meeting, Mansfield and colleagues presented an update on a chemoimmunotherapy combination comprised of atezolizumab (Tecentriq), carboplatin, and etoposide. Other studies have looked at temozolomide (Temodar) plus PARP inhibitors, says Mansfield. There are also proteins expressed in SCLC that researchers are trying to target with antibody-drug conjugates. Most of these trials have been negative, although not due to a lack of effort, Mansfield concludes.