Small Cell Lung Cancer 2025 x Dr. Stephen Liu Part 2
Jan 27, 2025
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In this engaging discussion, Dr. Stephen Liu, an international lung cancer expert and Director at Georgetown Lombardi Cancer Center, dives into the intricacies of extensive stage small cell lung cancer. He highlights breakthroughs in therapies from the Empower 133 and Caspian trials, addressing the integration of immunotherapy. The podcast tackles the controversial use of prophylactic cranial radiation and explores innovative treatments like Tarlatamab. Additionally, Dr. Liu shares invaluable career advice for budding oncologists, stressing the importance of mentorship and personal values.
The incorporation of immunotherapies like atezolizumab and dervalumab in chemotherapy regimens has significantly improved survival rates for extensive stage small cell lung cancer (SCLC).
Dr. Liu advocates for introspection among trainees, emphasizing that career choices should align with personal values and interests for greater fulfillment.
Deep dives
New Treatment Regimens for Extensive Stage Small Cell Lung Cancer
The discussion highlights significant advancements in the treatment of extensive stage small cell lung cancer (SCLC), primarily through the incorporation of immunotherapies. The Empower 133 trial demonstrated that adding atezolizumab to a standard chemotherapy regimen (carboplatin and etoposide) resulted in an improvement in survival rates, notably achieving a 24% reduction in the risk of death. Although the median survival increase was modest, from 10.3 to 12.3 months, there are indications that a small subset of patients may experience remarkable long-term benefits, potentially including cures. This trend is reinforced by the Caspian study, which similarly found that adding dervalumab to chemotherapy yielded positive survival outcomes, establishing the role of PD-1 and PD-L1 inhibitors in the treatment paradigm for extensive SCLC.
The Role of Prophylactic Cranial Radiation
The effectiveness of prophylactic cranial radiation (PCI) in extensive stage SCLC is questioned, having shown limited benefits in older studies that lacked modern screening techniques like MRI. While PCI reduced the rate of brain metastases in one historical study, new research led by Dr. Takahashi revealed that while PCI still reduced the risk of brain metastases, it did not translate to improved overall survival. Furthermore, the potential toxicity associated with PCI, such as cognitive decline and memory impairment, raises concerns about its use, particularly considering its optional status in current phase three trials. Consequently, the use of PCI in extensive stage SCLC is decreasing, as clinicians weigh the modest survival benefits against long-term impacts on patients' quality of life.
Emerging Insights into Maintenance Therapy
Maintenance therapy has become a critical area of research in extensive stage SCLC, given the high response rates to initial chemotherapy often followed by rapid relapse. While early studies attempting to integrate maintenance immunotherapy with nivolumab did not yield significant improvements, the upcoming MFORTE trial demonstrated that using lerbanectidin as a maintenance treatment positively impacted both progression-free survival and overall survival. This suggests that effective maintenance strategies might extend treatment efficacy and improve patient outcomes, leading to excitement around upcoming clinical presentations. Additionally, the search for optimal treatment sequences, including whether to utilize agents like tarlatimab or to explore novel combinations, underscores the need for continuous innovation in this field.
The Importance of Career Reflection for Oncologists
Dr. Liu emphasizes the significance of internal reflection for trainees and early-career oncologists when shaping their career paths, urging them to consider their motivations and values. Rather than choosing a specialty based on prestige or external expectations, he advocates for selecting roles based on personal satisfaction and genuine interest in the work involved. This introspective approach can lead to more fulfilling career choices and ultimately better patient care, as physicians engage in areas they are passionate about. Exploring various roles in clinical settings, industry, or academia can optimize fulfillment while aligning career decisions with individual priorities such as work-life balance, mentorship opportunities, or desired geographic locations.
This week’s episode will be focusing on additional details for Extensive Stage Small Cell Lung Cancer (SCLC), options for relapsed/refractory disease & advice for trainees. We are so excited to welcome back Dr. Stephen Liu international expert for lung cancer, Director of Thoracic Oncology & Developmental Therapeutics at Georgetown Lombardi Cancer Center and Co-Host of the IASLC Podcast.
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