Emerging Role of Neoadjuvant Strategies in Limited-Stage SCLC

Early data presented at the World Lung Cancer Conference suggests potential for neoadjuvant chemoimmunotherapy in resectable stage II to IIIB limited-stage small cell lung cancer (SCLC), though the experts emphasize this remains investigational. The small study of 25 patients, with 16 proceeding to surgery, demonstrated encouraging response rates of 84% and pathologic complete response rates of 50%. Dr Leal notes the impressive 18-month event-free survival of 76% in the surgery group compared to 33% in the radiation group, though overall survival data remains immature and longer follow-up is essential.

The panel draws parallels to the transformative impact of neoadjuvant chemoimmunotherapy in non–small cell lung cancer while acknowledging the unique challenges in SCLC. Dr Cooper highlights the potential for improved outcomes given SCLC’s chemotherapy responsiveness and known immunotherapy benefits but emphasizes the need for larger studies to validate these preliminary results. The more aggressive nature of SCLC raises concerns about disease progression during neoadjuvant therapy and the importance of careful patient selection to ensure operability throughout the treatment course.

Practical considerations include the need for thorough upfront staging to avoid treatment delays and comprehensive evaluation of surgical candidacy before initiating neoadjuvant therapy. The experts stress that patients must be evaluated by experienced thoracic surgeons to ensure operability, as starting neoadjuvant therapy without definitive surgical plans could compromise outcomes. Dr Sands mentions the upcoming Alliance Foundation trial investigating adjuvant durvalumab in surgically resected T1-2N0 SCLC, representing another approach to incorporating immunotherapy into earlier-stage disease treatment paradigms while the neoadjuvant approach undergoes further investigation.