EP. 2A: Treatment Challenges and Unmet Needs in Extensive-Stage Small Cell Lung Cancer

EP: 1.EP. 1: Extensive-Stage Small Cell Lung Cancer Treatment Landscape

Now Viewing

EP: 2.EP. 2A: Treatment Challenges and Unmet Needs in Extensive-Stage Small Cell Lung Cancer

EP: 3.EP. 2B: Challenges Affecting the Management of Extensive-Stage Small Cell Lung Cancer

EP: 4.EP. 3: Management of Extensive-Stage Small Cell Lung Cancer Treatment-Related Events

EP: 5.EP. 4A: The Role of Trilaciclib in the Management of Chemotherapy-Induced Myelosuppression in SCLC

EP: 6.EP. 4B: Considering Chemotherapy-Induced Myelosuppression and the Impact of Trilaciclib on Its Management

EP: 7.EP. 5: Clinical Trial Evidence for the Myeloprotective Benefit of Trilaciclib for Chemotherapy-Induced Myelosuppression

EP: 8.EP. 6A: Benefits of Using Trilaciclib in Patients With Extensive-Stage Small Cell Lung Cancer in Clinical Practice

EP: 9.EP. 6B: Clinical Experience With Trilaciclib in Patients With Extensive-Stage Small Cell Lung Cancer

EP: 10.EP. 7: Clinical Trial Evidence for Chemoprotectant Benefit of ALRN-6924 for Chemotherapy-Induced Myelosuppression

EP: 11.EP. 8A: Considerations for Reactive and Proactive Approaches to the Management of Chemotherapy-Induced Myelosuppression in Extensive-Stage Small Cell Lung Cancer

EP: 12.EP. 8B: Reactive and Proactive Treatment Approaches for the Management of Chemotherapy-Induced Myelosuppression

EP: 13.EP. 9A: The Rationale for CDK4/6 Inhibition in ES-SCLC and Updates on Trilaciclib Clinical Trial Data

EP: 14.EP. 10A: Impact of Trilaciclib on Chemotherapy-Induced Myelosuppression in Patients with ES-SCLC

EP: 15.Episode 10B: Impact of Trilaciclib on Chemotherapy Induced Myelosuppression (CIM) in ES-SCLC

EP: 16.Episode 11A: Effect of Trilaciclib in Patients Receiving Chemotherapy for ES-SCLC Treatment

EP: 17.Episode 11B: The Effect of Trilaciclib in Patients Receiving Chemotherapy for ES-SCLC Treatment

EP: 18.EP 12A: Managing Thrombocytopenia in Patients receiving Chemotherapy for ES-SCLC

EP: 19.EP 12B: Management of Chemotherapy Induced Myelosuppression (CIM) in ES-SCLC

In my opinion, the unambiguously greatest challenge in treating extensive-stage small cell lung cancer is [the] lack of therapeutic efficacy. The duration of control that we get is grossly inadequate, [and] our survival is grossly inadequate. Along the way, our patients suffer not just from the [adverse] effects of what we do to them—although I would list that as another really important unmet need—they also suffer from the effects of our therapy, so we need therapies that are more effective. Ideally, curing some or really all patients, we need treatments that are less toxic.

First-line treatment of extensive-stage small cell lung cancer changed dramatically in 2019 with the approval of atezolizumab. For a very long time until then, the evolution of frontline regimens never improved survival. Enter IMpower-133: This was a randomized study of carboplatin and etoposide, plus either placebo or the PD-L1 inhibitor atezolizumab. We have an improvement in progression-free survival, we have an improvement in overall survival, and [there was] not much extra toxicity. There were some immune-related adverse events that you see with the addition of atezolizumab, of course, but looking at the safety profile globally, [there was] not a terribly big increase.

The same was pretty much replicated in 2020 in the CASPIAN study with the addition of the PD-L1 inhibitor durvalumab to platinum and etoposide. The addition of the PD-L1 inhibitor, the approved ones being atezolizumab or durvalumab, to standard platinum and etoposide improved survival in extensive-stage small lung cancer. This, of course, has changed the standard of care. In the US and other countries that can afford it, the absolute unambiguous standard of care for patients eligible for a checkpoint inhibitor is platinum, etoposide, and a checkpoint inhibitor.

If you look at the toxicity tables of the regimens that have defined our standard of care. If you look at IMpower-133, if you look at CASPIAN, if you look at the phase I basket results of lurbinectedin, [and] if you look at any of the dozen or so topotecan trials, what you can see is that the majority of patients are experiencing adverse events. The most common of these are myelosuppressive events, which until very recently we couldn't do a whole lot about.

For years, we haven't thought that much about myelosuppression other than maybe neutropenia because we had a bit of a learned helplessness. This was the cost of business to giving cytotoxic drugs, and we started to say, "Well of course, you get tired. Of course you get anemic." It was a learned helplessness, but that changed some with the introduction of effective drugs to protect neutrophils. The [drugs] had their own imperfections, but to me, trilaciclib is important not only for the drug itself, which I am using in every eligible [patient with] small cell [lung cancer], but [also] for the way we think about supportive care for blood counts in general. We should be thinking about myelosuppression again now that we can actually do something about it.