Question: I have small cell lung cancer (SCLC). What’s new in research related to SCLC? What should I know about clinical trials? 

(Answered by Dr. Jacob Sands from Dana-Farber Cancer Institute during his appearance on the Lung Cancer Living Room. It has been edited slightly for this use.)  

Answer: There is a lot of research being done on SCLC with a strong focus on finding new and better treatments.  

DLL3-targeted drugs 

The most novel therapies right now are those that target DLL3. DLL3 is a receptor on the surface of many small cell lung cancers. The study that is furthest along as of the end of 2023 is a drug called tarlatamab, which binds DLL3 and immune cells together, creating an immune response that enables the immune system to attack and kill the cancer cells. Like other immunotherapies, we’re seeing a subset of individuals that have extraordinary outcomes and long-term disease control with this drug. There are other drugs in this class in addition to tarlatamab that also bind the cancer cells and immune cells together.  

Antibody drug conjugates (ADCs) 

Other drugs now being developed have a different target for the immune cell. They bring in a different kind of cell from the immune system along with the cancer cell to create an immune response. These drugs are called antibody drug conjugates (ADCs). These drugs bind to a receptor on the surface of the cancer cell and release the chemotherapy inside the cell. It’s kind of like a targeted chemotherapy and there are now multiple different receptors that are being utilized in this way. We are essentially accessing “doors” to SCLC to be able to deliver chemotherapy into the cells.  

SCLC subtypes 

In addition to the above studies, researchers have been able to find four broad subtypes of SCLC. How to test for these in a way that is scalable is something that still needs to be sorted out, but what this means is there are a lot of new ideas about how these subtypes might affect treatment outcomes. For example, if we were to take a drug that is in development and say, “Wow, it tends to work better for this subtype than others,” we can really focus the treatment on people with that subtype.  

Clinical trials 

People with SCLC should start having conversations with their health care providers about clinical trials right at the beginning. SCLC tends to grow rapidly so it’s not necessarily something where you want to wait to start treatment, particularly when someone is having symptoms. But if you are able to wait, and you’re interested in a trial, when you contact one of the academic centers, it’s good to highlight that you haven’t yet gotten treatment because it’s possible that this will fast track you for the oncologist running these trials.  

If someone’s treatment has already started, because the first-line treatment for SCLC is pretty standard, I almost always encourage them to continue to get treatment with their oncologist. Where trials become really important is in the second line. If you’re on first-line treatment and the cancer grows, you want to be seen in one of the centers that has clinical trials available. And you can be seen now, while still on first-line treatment, and say, “I want to see someone just so that I’m set up for what’s next.” You want to make sure you have a plan for when it grows that there’s someone you’re going to get in with urgently. 

If you would like to learn more about SCLC, please visit our SCLC webpage. 

Please note that the information included in any published answer is for educational pursuit only and is not intended or implied to be a substitute for professional medical advice. The reader should always consult their healthcare provider to determine the appropriateness of the information for their own situation. Nothing from GO2 for Lung Cancer should be construed as an attempt to offer or render a medical opinion.