Advancements in the Treatment and Management of SCLC: Updates From ASCO 2025 - Episode 1
Panelists agreed the ADRIATIC trial is practice-changing for limited-stage small cell lung cancer, establishing durvalumab as the new standard post chemoradiation due to its significant survival benefit and manageable toxicity, while also highlighting the need for multidisciplinary coordination and raising questions about agent selection and evolving radiation strategies.
The panelists unanimously recognized the ADRIATIC trial as practice-changing in the treatment of limited-stage small cell lung cancer (LS-SCLC). The trial demonstrated a remarkable 22-month improvement in overall survival with consolidation durvalumab following chemoradiation, a significant breakthrough after decades of limited progress in LS-SCLC. Experts noted that the data led to immediate integration of durvalumab into their practices, highlighting its manageable toxicity and the profound benefit in preventing early relapse. While the trial called for up to 2 years of durvalumab, most patients completed approximately 9 cycles, yet long-term survival still extended well beyond treatment duration.
In contrast, the panel expressed surprise and caution regarding the negative results from the ATESO trial, which evaluated atezolizumab in a similar postchemoradiation setting and failed to show benefit. This raised questions about differences in immunotherapy agents, with the consensus being that durvalumab is now the standard of care, while atezolizumab appears less effective in this context. The discussion also touched on controversies around radiation, specifically the lack of robust randomized data in the modern MRI era regarding prophylactic cranial irradiation and daily vs twice-daily radiation, urging caution in overinterpreting subgroup analyses.
Multidisciplinary coordination was emphasized as vital to effective LS-SCLC care. The panel agreed on individualized approaches when deciding between cisplatin vs carboplatin, often favoring carboplatin due to its better toxicity profile, especially in patients who are older or have more comorbidities. The evolving evidence base underscores the importance of team-based decisions, involving both medical and radiation oncologists. The durability of response and long survival seen in ADRIATIC has reinvigorated optimism in LS-SCLC management, with the experts hopeful this signals a broader shift toward more effective and tolerable long-term control.