Dr. Rami Manochakian on Translating Major Developments in SCLC Treatment

With a major plenary session at the 2024 American Society of Clinical Oncology Annual Meeting and a recent drug approval, treatment for small cell lung cancer (SCLC) is evolving at a rapid pace. However, it’s critical to translate these advances into practice so patients can access them in the community setting.

Advancements in Oncology, hosted by The Oncology Brothers on Saturday, June 1, played a key role in communicating the most noteworthy and practice-changing updates in lung cancer for community oncologists.

From the role of surgery and the perioperative setting, to advances in the treatment of non-small cell lung cancer and using targeted therapies to treat patients with actionable mutations, the event distilled the latest developments in lung cancer into a digestible format.

Rahul Gosain, MD, MBA, and Rohit Gosain, MD, known collectively as The Oncology Brothers, sat down with panelist Rami Manochakian, MD, FASCO, of the Mayo Clinic, Florida, to discuss the latest on SCLC.

The 2024 American Society of Clinical Oncology Annual Meeting was filled with historic updates in lung cancer, including the practice-changing plenary presentation of the phase 3 ADRIATIC study.

The double-blinded and placebo-controlled global study evaluated durvalumab plus or minus tremelimumab in 730 patients with stage I-III limited-stage SCLC (LS-SCLC) who had not progressed after concurrent platinum-based chemoradiotherapy.

Dr. Rohit Gosain asked Dr. Manochakian how he thought ADRIATIC would change the treatment landscape for LS-SCLC. While the June 1 event was held on the eve of the ADRIATIC plenary that revealed additional details from the primary analysis of the phase 3 trial, Dr. Manochakian shared his initial thoughts and impressions.

“This is going to be, in my opinion, a practice-changing standard of care,” Dr. Manochakian said, noting that when he sees a patient with SCLC, he tells them, “We need to start treatment as soon as possible.”

However, while SCLC “responds very nicely” to chemoradiation, the unfortunate reality for many patients is that their disease progresses after chemoradiation, Dr. Manochakian said.

“We’ve had nothing after [chemoradiation]. That’s it. They basically sit tight and wait, and the majority of patients, their disease progress. Now, we’re seeing significant improvement…I think this is going to be, definitely, practice-changing for these patients.”

They also discussed advances in extensive-stage SCLC (ES-SCLC), including the recent accelerated approval of tarlatamab-dlle for patients with ES-SCLC who have disease progression on or after platinum-based chemotherapy.

“[We’re] talking about a dire unmet need where we have not seen major changes, but lately, we have been lucky enough, especially in the metastatic or extensive-stage setting, [with] tarlatamab,” Dr. Rohit Gosain said.

The drug, a bispecific T-cell engager, comes with unique administration considerations and side effects such as cytokine release syndrome, Dr. Manochakian said.

“We are not used to something in the solid tumor like this,” he said. “All institutions, academic or community, have to start talking…talk to your team, talk to your pharmacy, talk to people, because it needs a little bit of a process.”