Multidisciplinary Approaches to Managing LS-SCLC: Immunotherapy, Paraneoplastic Syndromes, and Post-CCRT Care

The panel emphasized the importance of timely initiation of durvalumab after completing chemoradiation, consistent with the ADRIATIC trial, which started immunotherapy within 42 days. Dr Metter noted that while “the sooner, the better” is a guiding principle, patient recovery is prioritized—especially after the demanding course of concurrent chemoradiation. Many patients experience esophagitis, fatigue, or cytopenias that may require time to resolve before starting a new therapy. Coordination with radiation oncologists during and after treatment helps assess when a patient is ready to proceed.

Dr Sands reiterated that close scheduling is essential, typically aiming to initiate durvalumab within 4 weeks of completing chemoradiation, though he allows flexibility based on the patient’s physical or psychological readiness. He also highlighted the importance of obtaining a posttreatment scan before starting immunotherapy, not necessarily to expect progression, but to establish a new baseline and rule out unexpected disease changes. Although the subgroup analysis suggested earlier initiation could be favorable, clinicians prioritize a patient-centered, individualized approach.

Dr Shields expanded on the multidisciplinary care model, which includes not only oncology and radiation but also neurology (especially for patients with paraneoplastic syndromes), supportive care teams, social workers, and nutritionists. She shared cautionary experiences where immunotherapy was withheld due to underlying neurologic conditions like Lambert-Eaton myasthenic syndrome or autoimmune encephalitis, where immunotherapy could potentially exacerbate symptoms. In such cases, collaboration with neurology and careful risk-benefit discussions with patients and families are essential. Overall, the panel agreed that initiating durvalumab promptly—while ensuring patient safety and recovery—is critical, and that multidisciplinary input is vital for optimizing timing, monitoring, and complex clinical decision-making in LS-SCLC.