Oncology Brothers: Practice-Changing Cancer Discussions Managing Side Effects of New Treatments for Small Cell Lung Cancer
Aug 29, 2025
Dr. Misty Shields, a medical oncologist at Indiana University specializing in small cell lung cancer, shares her insights on managing side effects from new treatments. She discusses the latest advancements from ASCO 2025, focusing on the treatment algorithm for patients with good performance status. Key points include common side effects of lurbinectedin and immunotherapy, strategies for managing hematologic toxicities, and the crucial role of supportive and palliative care in improving patient quality of life. Collaboration between community oncologists and academic centers is emphasized for optimal care.
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Post‑ASCO 2025 Treatment Algorithm
- ASCO 2025 changed the treatment algorithm for extensive-stage SCLC with chemoimmunotherapy front-line followed by lurbinectedin in maintenance and tarlatamab at relapse.
- Dr. Misty Shields implemented these regimens immediately and emphasizes logistics and equitable access.
Prevent Hematologic Toxicity Early
- Anticipate hematologic toxicity with lurbinectedin added to chemoimmunotherapy and plan aggressive supportive care.
- Use prophylactic G-CSF to reduce neutropenic fever risk and select patients with good hematologic reserve.
Distinguish Liver Toxicities Carefully
- Differentiate liver injury patterns to decide whether immunotherapy or lurbinectedin is responsible.
- Monitor bilirubin and transaminase patterns, check for fevers, and reassess for liver metastases or underlying disease.