By Rashmi Acharya, MS, Coordinator, Science & Research, GO2 for Lung Cancer

Unlocking the Biology of SCLC

Patients with small cell lung cancer (SCLC) receive one-size-fits-all treatment because of limited knowledge about the biology of the disease. There are currently no actionable biomarkers for SCLC; thus immunotherapy and chemotherapy in combination mark the standard of care.

There are, however, exciting new developments in the SCLC biomarker space. Researchers at the American Society of Clinical Oncology’s (ASCO) Annual Meeting announced that they have identified four major subtypes of small cell lung cancer, each with distinct characteristics. Their hope is that these can be used to enable distinct treatments for SCLC subtypes—breaking the one-size-fits-all mode.

An analysis of the data from current and previous studies suggests that one of these subtypes (SCLC-inflamed) is more responsive to immunotherapy treatment. The other three subtypes express different markers (ASCL1, NeuroD1, and PAU2F3) that can potentially be used to match targeted therapies or other treatments for each subtype.

Knowledge of the four subtypes is also helping to better understand why small cell lung cancer has been so resistant to treatment. As more definite markers and treatments are identified for each subtype, more biomarker-driven trials can be conducted, bringing hope for new treatments for SCLC in the coming years.

Based on the idea of markers, tarlatamab targets a common SCLC marker, DLL3, to attack tumor cells. Early data on the drug shows that some participants had good responses., We expect to see more clinical trials (and clinical trial data) in the future.

Radiation Therapy for SCLC

Also new from ASCO 2021, researchers shared the results of multiple studies on the role of radiation in the treatment of small cell lung cancer. One of these studies showed that a higher dose (70 gray) of radiation once a day is not better (based on survival and side effects) than a standard dose (45 gray) of radiation twice per day in limited stage SCLC. (Trials are ongoing on radiation and immunotherapy combinations to determine the effectiveness of the combination in extensive stage SCLC.) There are also several ongoing studies considering the role of brain radiation in the management of brain metastases in patients with SCLC.

As more research is carrying out in the SCLC space, patient participation is crucial to identifying new treatments for SCLC. Contact a LungMATCH navigator for information about joining a clinical trial.