General Goodies
This is the (ballpark) estimate 5 year overall survival for small cell lung cancer.
What is 5 year survival rate is 7%, 5-year lung cancer specific survival 21.7%?
This is the definition of limited stage.
What is Limited - if it can be radiated in one field; 30-40% Stage 1-3, one hemithorax and regional lymph nodes only?
This is the definition of extensive stage
What is Extensive stage spread to contralateral lung, pleural effusion or distant metastases?
This is the doubling time of SCLC?
What is 20-30 days?
Smoking is the number 1 risk factor for SCLC. T/F Number of packs is more important than duration.
What is false? Duration more important than packs
Surgery may be considered in these stages
What is T1-2, N0 or stage I/IIA?
tumor < 5 cm - lobectomy is preferred
This is initial SOC for extensive stage SCLC
What is platinum/etoposide + immunotherapy?
T/F The CONVERT study showed superiority of twice daily radiation to once daily
What is false?
CONVERT study - once daily or twice daily radiation; no significant difference in OS, PFS, or toxicity; twice daily radiation still standard of care but can do once daily if needed
Loss of these two molecular markers are found universally in small cell lung cancer
What are loss of RB1 and p53?
Frequent MYC family amplifications are also seen
Can check for RB1 loss to confirm small cell transformation
For all other limited stage tumors, this is initial standard of care treatment
What is chemoradiation with 4 cycles of platinum-etoposide, started during C1-2) +/- immunotherapy
Which trials support the use of atezolizumab and durvalumab in extensive stage SCLC?
What are IMPOWER 133 and CASPIAN study?
What is the MOA of trilaciclib and its function in treatment?
What is CDK 4/6 inhibitor and myeloprotection - arrests hematopoietic stem and progenitor cells in the G1 phase of the cell cycle?
IV infusion: 30 minutes before chemotherapy on each day of chemo (FDA approved in 2021) - no real side effects; adds more chair time
This is what is seen on light microscopy and electron microscopy for SLCL.
What are LM: Small round blue cells, high N:C monotonous undifferentiated morphology
EM: sparse dense core granules?
Describe the results of the ADRIATIC trial
ADRIATIC trial - durvalumab every 4 weeks, for limited stage after chemoradiation increased OS (OS) standard of care; (also allowed for carboplatin, prior standard was cisplatin); shows potential benefit of durvalumab 55 vs 33 months - lots of people treating with this - ASCO 2024; Patients who had PCI 3-Year OS Rates: 62.1% (durvalumab) vs 56.5% (placebo); 3-Year OS Rates: 50.2% vs 37.3%
If patients have a good initial response with reduction of metastases, what can be added afterwards?
What is consolidative thoracic radiation?
Phase 3 TRIAL ED-SCLC 2 year OS - 13% vs 3%; decrease in intrathoracic recurrence
Prophylactic treatment of cisplatin with this may reduce AKI and hospitalization.
What is Magnesium?
This is the IHC staining for SCLC.
What is
IHC: NE differentiation - chromogranin, synaptophysin
Pathology stains positive chromograminin, synaptophysin, TTF1, NPM CD56?
This is the role of PCI in local small cell lung cancer
What are Reduced brain metastases (from 59% to 33%) and Improved overall survival (5.4% absolute improvement at 3 years)?
Ongoing investigations of MRI surveillance vs PCI though SOC is still PCI for boards
This is the role of PCI in extensive stage SCLC?
What is controversial, surveillance of brain is favored (PFS 14.7 vs 12 weeks, OS 6.7 vs 5.4 months, criticism is that they didn’t have to get MRI before PCI)
Was closed in other phase 3 trial due to futility - longer OS in placebo than PCI
What are relapsed small cell lung cancer treatment options?
CLINICAL TRIAL IS PREFERRED
If > 6 months - platinum sensitive; platinum doublet - cis/carbo/etop
If 3 - 6 months - topetecan (cytopenias, fatigue, etc.), taxanes, irinotecan, TMZ, gemcitabine, lubernectedin (basket trial - response rate of 35% - better in platinum sensitive), ENFORTE - lubernectedin maintenance improved OS and PFS)
If < 3 months = refractory - any of above, lubernectidin, or immunotherapy if they didn’t get initially
Tarlatimab (AMG5757) - bispecific T cell engager (BITE)
Binds TLL3 and CD3 (DELLPHI-301); ORR 40%; FOR 10-13 months; Median OS 13-14 months; similar or better ORR; manageable ICANS; CRS grades 1-2, ICANs - preferred second line over lubernectedin but logistical issues may delay care
Tumor Treating Fields