Immunotherapy Treatments for Small Cell Lung Cancer (SCLC)

*Please note: This slide show is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor about any questions you may have regarding a medical condition.

Is immunotherapy right for your SCLC? Staging

Your doctor will talk with you about whether immunotherapy is an option for your SCLC. Factors to consider include:

• The stage of your cancer. Staging is a way of measuring how much cancer is in your body.

Is immunotherapy right for your SCLC? Treatment history

Factors to consider include:

• Whether you've been treated for small cell lung cancer before and what kind of treatment you received.

Is immunotherapy right for your SCLC? Extensive-stage SCLC

Your doctor may recommend immunotherapy if your cancer has spread:

• Widely in one lung
• To the other lung
• To lymph nodes near the lungs
• From the lungs to other organs

If your cancer has spread in any of these ways, it is called extensive-stage small cell lung cancer.

When is immunotherapy right as a first treatment for extensive-stage SCLC?

If you have extensive-stage SCLC and have not been treated for small cell lung cancer before, your doctor may recommend that you start treatment with a combination of immunotherapy and chemotherapy drugs.

When is immunotherapy right as a later treatment for extensive-stage SCLC?

If your extensive-stage SCLC has come back after chemotherapy, your doctor may recommend an immunotherapy drug called tarlatamab, a bispecific T-cell engager (BiTE therapy). This kind of immunotherapy links a patient's T-cells to cancer cells so that the immune system attacks the tumor cells.

When is immunotherapy right as a later treatment for extensive-stage SCLC?

In clinical trials, people who were treated with tarlatamab lived longer than those whose extensive-stage SCLC came back after chemotherapy but did not receive tarlatamab.

When is immunotherapy right as a treatment for limited-stage SCLC?

Durvalumab is an immunotherapy drug that has been used to treat extensive-stage SCLC for several years. It was recently approved to treat limited-stage SCLC that has not gotten worse after treatment with chemotherapy and radiation together.

Limited-stage SCLC is cancer in just one side of the chest. It may be in only one lung and sometimes lymph nodes on that side of the chest.

What are clinical trials? Is a clinical trial right for me?

Clinical trials are research studies that find out if a new cancer treatment works better than existing treatments. Ask your doctor if enrolling in a clinical trial is right for you.

What side effects can occur from immunotherapy?

Side effects can occur when an immunotherapy drug attacks healthy cells. Common side effects include:

• Feeling tired and weak
• Pain in the muscles, joints, or stomach
• Loss of appetite
• Itching
• Diarrhea
• Skin rash

What side effects can occur from immunotherapy?

Serious but treatable side effects from tarlatamab can include breathing problems, low blood pressure, or neurologic problems. You may be observed in the hospital overnight after the first two doses.

How are immunotherapy side effects treated?

Always talk with your healthcare team about any side effects you are having.

Side effects of immunotherapy are often treated with drugs that suppress your immune system. Your immunotherapy will be stopped until the side effects clear up.

It's important to discuss all of your treatment options and possible side effects with your healthcare team, so you can make decisions that are right for you. If there’s anything you don’t understand, ask to have it explained.

References

1. American Cancer Society. Immunotherapy for Small Cell Lung Cancer. Last revised: March 31, 2020.
   https://www.cancer.org/cancer/lung-cancer/treating-small-cell/immunotherapy.html
2. American Cancer Society. Treatment Choices for Small Cell Lung Cancer, by Stage. Last revised: March 31, 2020.
   https://www.cancer.org/cancer/lung-cancer/treating-small-cell/by-stage.html
3. Columbus G. Atezolizumab Triplet Approved by FDA for Frontline SCLC. Targeted Oncology. March 19, 2019.
   https://www.targetedonc.com/view/atezolizumab-triplet-approved-by-fda-for-frontline-sclc
4. Cooper MR, Alrajhi AM, Durand CR. Role of Immune Checkpoint Inhibitors in Small Cell Lung Cancer. Am J Ther. 2018 May/Jun;25(3):e349-e356.
5. Kalemkerian GP, Loo BW, Akerley W, Attia A, Bassetti M, Boumber Y, Decker R, Dobelbower MC, Dowlati A, Downey RJ, Florsheim C, Ganti AKP, Grecula JC, Gubens MA, Hann CL, Hayman JA, Heist RS, Koczywas M, Merritt RE, Mohindra N, Molina J, Moran CA, Morgensztern D, Pokharel S, Portnoy DC, Rhodes D, Rusthoven C, Sands J, Santana-Davila R, Williams CC, Hoffmann KG, Hughes M. NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018. J Natl Compr Canc Netw. 2018 Oct;16(10):1171-1182.
6. National Cancer Institute. Atezolizumab. Last revised: June 8, 2020.
   https://www.cancer.gov/about-cancer/treatment/drugs/atezolizumab
7. National Cancer Institute. Durvalumab. Last revised: March 30, 2020.
   https://www.cancer.gov/about-cancer/treatment/drugs/durvalumab
8. National Cancer Institute. Nivolumab. Last revised: June 17, 2020.
   https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab
9. National Cancer Institute. Pembrolizumab. Last revised: July 9, 2020.
   https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab
10. Postow M, Wolchok J. Special considerations and toxicities associated with checkpoint inhibitor immunotherapy. UpToDate, Inc. 2020.
    https://www.uptodate.com/contents/special-considerations-and-toxicities-associated-with-checkpoint-inhibitor-immunotherapy
11. Scott R. Tarlatamab sustains responses, shows long-term tolerability in heavily pretreated SCLC. OncLive. September 10, 2024.
    https://www.onclive.com/view/tarlatamab-sustains-responses-shows-long-term-tolerability-in-heavily-pretreated-sclc
12. Stenger M. Pembrolizumab in Metastatic Small Cell Lung Cancer. The ASCO Post. August 10, 2019.
    https://www.ascopost.com/issues/august-10-2019/pembrolizumab-in-metastatic-small-cell-lung-cancer
13. Tam WW. Small Cell Lung Cancer (SCLC) Treatment & Management. Last revised: April 3, 2020.
    https://emedicine.medscape.com/article/280104-treatment#d11
14. US Food & Drug Administration. FDA approves durvalumab for limited-stage small cell lung cancer. Last revised: December 4, 2024.
    https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-durvalumab-limited-stage-small-cell-lung-cancer