Advancing Equitable Access to Targeted and Immuno-Oncology Therapies in SCLC: Angel Qin, MD

Angel Qin, MD, thoracic medical oncologist and associate professor at the University of Michigan, discussed the evolving landscape of small cell lung cancer (SCLC) treatment, focusing on recent clinical trial data and their impact on patient care. She highlighted the ADRIATIC trial, which reinforced the crucial role of immunotherapy in the adjuvant setting for SCLC and suggested a potential for bringing it into even earlier stages of treatment, in an interview with The American Journal of Managed Care®.

Qin also served as a panelist at the Detroit Institute for Value-Based Medicine (IVBM) on the session titled "Value-Driven Precision: Advancing Equitable Access to Targeted and Immuno-Oncology Therapies in Lung Cancer.” She addressed the IMforte trial, noting that while approval is pending, this regimen is likely to offer incremental survival benefits for patients.

This underscores the potential of combination immunotherapy as a maintenance therapy. The discussion concluded by emphasizing the need for more effective post-chemotherapy immunotherapies and improved molecular characterization to enable personalized treatment.

This transcript was lightly edited; captions were auto-generated.

Transcript

How will the data from the ADRIATIC trial and other recent advancements specifically shift clinical decision-making processes for individual patients with limited-stage SCLC?

I think that's a really great question. The ADRIATIC study (NCT03703297) was presented last year, and we saw that with the addition of 2 years of adjuvant durvalumab for patients who complete concurrent chemoradiation for small cell lung cancer, there wasn't a significant improved survival. I think that really cements the role of immunotherapy in the adjuvant consolidation setting, very similar to what we already do for non–small cell lung cancer, except this is 2 years vs 1 year.

I think this really speaks to the fact that patients with small cell lung cancer truly do benefit from immunotherapy, and the magnitude seems to be higher when patients are at that limited stage, which is so important because that's the curative intent setting. I think it's definitely dramatically changed our standard of care, and I think there's probably going to be interest in now bringing immunotherapy to perhaps even earlier stages of small cell lung cancer.

Regarding the IMforte trial, what does the observed survival benefit signal about the role of combination immunotherapy as maintenance therapy, and how might this affect future guidelines?

We're still waiting to see whether the IMforte (NCT05091567) regimen will be approved. That is for patients after induction chemo and atezolizumab, they will get lurbinectedin and atezolizumab as a maintenance [therapy]. I think that there is a survival benefit, and I think in extensive-stage small cell it's really hard to shift survival in giant leaps and bounds. We see increments of a couple months at a time, but I think that is how progress is made.

I think we're waiting to see if it will be approved. I suspect it probably will be, and I think this is something we could apply clinically. I think the safety signal of the combination is what we would probably expect. It doesn't seem to be significantly more toxic. I think there might be something worth doing with chemo immunotherapy maintenance. We kind of do that already in non–small cell lung cancer in the adenocarcinoma setting, so I can imagine having some chemo with immunotherapy; that's why it's also translating to benefit in the small cell setting.