ASCO 2024: Immunotherapy for the Treatment of Small Cell Lung Cancer - Episode 4

Examining 3-Year Update Data from the CASPIAN Trial

July 2, 2024

Ticiana A. Leal, MD, Anne Chiang, MD, PhD, Yale School of Medicine Smilow Cancer Hospital, Afshin Dowlati, MD, Case Western Reserve University, Tarita O. Thomas, MD, PhD

A medical expert discusses the impact of the 3-year overall survival data from the CASPIAN trial on the treatment landscape for extensive-stage small cell lung cancer (ES-SCLC), emphasizing the significance of the long-term follow-up results in shaping the current treatment paradigm.

EP. 1: Optimizing First-Line Therapy for Limited-Stage Small Cell Lung Cancer

EP. 2: ADRIATIC Trial: Durvalumab, cCRT Timing, and Survival in LS-SCLC

EP. 3: cCRT-to-Durvalumab Interval in Limited Stage LS-SCLC

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EP. 4: Examining 3-Year Update Data from the CASPIAN Trial

Please review the 3-year overall survival update from the CASPIAN trial, assessing durvalumab ± tremelimumab plus platinum-etoposide in the first-line treatment of ES-SCLC, and discuss the impact of these findings on the treatment landscape. (Paz-Ares L, et al. ESMO Open. 2022: 7(2):100408)
1. Please comment on how clinical outcomes from this trial have influenced the treatment algorithm for ES-SCLC and the importance of the long-term follow-up data.
2. From a clinical perspective, how impactful to you and to your patients with ES-SCLC is the survival rate, which tripled from 6% to 18% at 3 years in the CASPIAN clinical trial?
3. With the updated CASPIAN trial outcomes and the endpoints from ADRIATIC, can we now extrapolate the survival benefits with immunotherapy, which apply to all stages of SCLC?
In the exploratory analysis of the CASPIAN Phase III clinical trial, a similar prevalence of neuroendocrine and non-neuroendocrine subtypes was detected in a subgroup of 104 patients with RNA sequencing data. However, Inflamed or YAP1 subtypes in the durvalumab + etoposide treatment arm experienced the longest overall survival.
1. What characteristics of these SCLC subtypes suggest that they may be betterprimed to respond to immunotherapy, and what are some future clinical implications of this finding?