Federico Albrecht, MD, comments on clinical trials supporting the use of PD-L1 inhibitor therapy in combination with standard chemotherapy for the treatment of patients with extensive-stage small cell lung cancer.
Albrecht says that ES-SCLC is aggressive and progresses quickly. Therefore, after initial treatment patients with ES-SCLC experience disease recurrence. There were 2 important clinical trials that provide guidance on how to approach treatment of these patients.
First, adding PD-L1 to standard chemotherapy was shown to improve survival in patients with ES-SCLC in the IMpower133 study (NCT02763579), which evaluated the use of atezolizumab (Tecentriq) in combination with the chemotherapy doublet, carboplatin plus etoposide. Initial findings published in the New England Journal of Medicine showed a median overall survival (OS) of 12.3 months with the addition of atezolizumab vs 10.3 months with chemotherapy alone. The median progression-free survival shown was 5.2 months with atezolizumab and chemotherapy compared with 4.3 months with chemotherapy alone. Updated findings published in the Journal of Clinical Oncology confirmed that chemotherapy plus atezolizumab is a standard of care.
In another study, CASPIAN (NCT03043872), the addition of durvalumab (Imfinzi) to platinum-etoposide or of tremelimumab (Imjudo) to platinum-etoposide led to significant improvements in OS in patients with ES-SCLC. Primary results showed a median OS of 13.0 months with added durvalumab vs 10.3 months with platinum-etoposide alone. Three-year OS analysis results from CASPIAN were presented at the European Society of Medical Oncology Congress in 2022, further demonstrating the durvalumab added to platinum-etoposide if a standard of care therapy for ES-SCLC.
