SCLC Staging Determines Treatment, Adverse Events

Staging plays a critical role in the treatment of small cell lung cancer.

Small cell lung cancer (SCLC) staging plays a crucial role in the decision-making process of a patient’s treatment regimen—thereby, in turn, dictating common adverse events that patients may face as well, explained Laura Sullivan, BSN, RN.

“The important thing to know is the staging of [the disease], whether it’s limited stage or extensive stage, and that really dictates the treatment plan,” Sullivan, who is a research study manager at the Rutgers Cancer Institute, said in an interview with Oncology Nursing News. “This allows the nurse to focus on the important points for the patients, what they need to look out for, and how to manage potential side effects that may occur.”

Limited-Stage Small Cell Lung Cancer

• The current National Comprehensive Cancer Network (NCCN) Guidelines for patients with limited-stage SCLC (meaning that it is stage I-III) is to treat with radiation and chemotherapy with curative intent.¹

“If it is a patient with limited-stage disease, and they’re receiving cisplatin—which is typically the standard in addition to etoposide—the nephrotoxicity that comes with the drug is really important to manage,” Sullivan explained.

To mitigate potential kidney damage, Sullivan emphasized the importance of educating patients about good hydration, especially before they come in for chemotherapy treatments. Additionally, IV fluids should be given alongside the chemotherapy.

Extensive-Stage Small Cell Lung Cancer

Extensive-stage (stage IV) SCLC, on the other hand, is a disease that has spread outside the bounds of 1 radiation field, and therefore, cure may not be an option. For these patients, the goal is to control symptoms and prolong life, according to the NCCN Guidelines.

For this patient population, the NCCN Guidelines recommend treatment with dual chemotherapy (carboplatin or cisplatin with etoposide) plus a checkpoint inhibitor (atezolizumab [Tecentriq] or durvalumab [Imfinzi]), followed by maintenance therapy with the checkpoint inhibitor.¹

“These are drugs that their purpose is to really rev up the immune system. So it’s important to address things to look out for,” Sullivan said, noting that cough is a common immunotherapy adverse event that patients should look out for and report to their health care team.

Ultimately, Sullivan urges patients to discuss their symptoms sooner rather than later.

“We reeducate the patient on how important to call if [anything] changes in their overall condition. The goal is to keep them out of the hospital, so if there are things that could be managed in the outpatient setting, it’s better for everybody,” she said.

Newer Treatment Options for Extensive-Stage Disease

More recently, the FDA approved tarlatamab-dlle (Imdelltra) for extensive-stage SCLC that progressed on or after platinum-based chemotherapy. This drug is a bispecific T-cell engager that targets DLL3.²

“Now to see an approved treatment for these patients is really exciting,” Sullivan said. “In addition to that, there are clinical trials that are really testing a lot of these novel agents to see if there are any benefit that is available for these patients that might not already be on the market or might be better than what is on the market.”

To continue to move the field forward, Sullivan said nurses should discuss the option of clinical trials with their patients.

“Start that conversation from the time of diagnosis about treatment option the standard of care options are always in your back pocket if needed, but maybe upfront investigating a clinical trial to see if there's any benefit to the patient while the patient still feels relatively well enough to participate.”

References

1. National Comprehensive Cancer Network. Small Cell Lung Cancer Guidelines. https://www.nccn.org/patients/guidelines/content/PDF/SCLC-patient-guideline.pdf. 2024. Accessed Oct. 10, 2024.

2. FDA News Release. FDA grants accelerated approval to tarlatamab-dlle for extensive stage small cell lung cancer. Published: May 16, 2024. Accessed May 16, 2024. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-tarlatamab-dlle-extensive-stage-small-cell-lung-cancer