Relapse and Survival in SCLC

Although SCLC is considered very responsive to initial chemotherapy and radiation, patients with disease recurrence have a low median duration of survival.1,2 This attribute of SCLC is the key challenge to developing new treatments, improving duration of response, and disease-free survival.2

STATISTICAL OVERVIEW2,3

PATIENTS WITH SCLC ARE
AT HIGH RISK OF RELAPSE

~75%
OF PATIENTS
with locally
advanced disease

AND

>90%
OF PATIENTS
with metastatic disease

PROGRESS WITHIN
2 YEARS OF TREATMENT

MEDIAN SURVIVAL DURATION

<2YEARS
FOR PATIENTS
with early-stage disease

AND

~1YEAR
FOR PATIENTS
with metastatic disease

AND

2-4
MONTHS
when untreated

IN PATIENTS WITH
RELAPSED SCLC

  • Many of these patients are candidates for additional systemic small cell lung cancer treatment1
    • Responses to second-line therapy vary based on the time from last therapy to relapse, the response to initial treatment, and overall performance status1,4

SEVERAL FACTORS DRIVE THE DECISION TO STOP TREATMENT AFTER FIRST-LINE IN LS-SCLC AND ES-SCLC PATIENTS5

Experience After First-line Treatment

70 Percent People Drawing

ONLY 70%
RECEIVED 2L TREATMENT5,6,a

2L=second-line.

aBased on data from a pooled analysis from Jazz Market Research in a total of 224 US-based oncologists that treat SCLC.
Research recruitment timeframe was April-May 2020 and 2021.5,6

  • Systemic therapy after first-line treatment failure remains an important component of the treatment paradigm7

About 17%* of patients move to hospice care once they experience progression after first-line treatment. Vigilant monitoring and early conversations are important to determine if patients could benefit from subsequent treatment.2,5,6

*Based on data from a pooled analysis from Jazz Market Research in a total of 224 US-based oncologists that treat SCLC.
Research recruitment timeframe was April-May 2020 and 2021.5,6

CHOOSING A SECOND-LINE THERAPY

  • When determining what the best second-line therapy for a patient may be, many HCPs evaluate if their disease is sensitive or resistant to first-line chemotherapy. They base this on the chemotherapy-free interval (CTFI), defined as the length of time from last platinum dose to time of relapse or disease progression4,7,8
  • However, there is no consensus in the literature as to what length of time determines different treatment decisions
    • For example, treatment recommendations in the NCCN Guidelines® are determined by CTFI >180 days, while the European Society for Medical Oncology (ESMO) clinical recommendations are dependent on a CTFI >90 days1,9
  • Subsequent systemic therapy provides significant palliation in many patients, although the likelihood of response is highly dependent on the time from initial therapy to relapse1
    • As such, recommendations for second-line treatment vary based on the time to relapse1
    • Longer relapse-free days post-completion of chemotherapy are thought to help contribute to a higher probability of second platinum response1,8
  • The optimal duration of subsequent systemic therapy has not been fully explored1
    • The most common and accepted approach is to continue treatment until progression or development of unacceptable toxicity beyond best response (for chemotherapy), progression of disease, or development of unacceptable toxicities1
    • Additional subsequent systemic therapy (eg, third-line) can be considered if patients are still performance status (PS) 0 to 21

Summary of Preferred Systemic Therapies in LS- and ES-SCLC1

FIRST-LINE TREATMENT

Limited Stage
red triangle
Small Cell Lung Cancer (SCLC) Chemotherapy DrawingSmall Cell Lung Cancer (SCLC) Radiotherapy Drawing

Platinum-based therapy +
concurrent
radiation therapy

Extensive Stage
red triangle
Small Cell Lung Cancer (SCLC) Chemotherapy DrawingSmall Cell Lung Cancer (SCLC) Immunotherapy Drawing

Platinum-based
therapy
+ immunotherapy


MAINTENANCE THERAPY

Limited Stage
Red Triangle Arrow

N/A

Extensive Stage
Red Triangle ArrowSmall Cell Lung Cancer (SCLC) Immunotherapy Drawing

Immunotherapy

Red Triangle Arrow

SUBSEQUENT THERAPY

Small Cell Lung Cancer (SCLC) Chemotherapy Drawing

Systemic therapy, original regimen, or clinical triala

aThe use of immune checkpoint inhibitors is discouraged if there is progression on maintenance atezolizumab or durvalumab at time of relapse.1

  • FDA-Approved Treatments for SCLC

    FDA SCLC ChartFDA SCLC Chart

    PD-L1=programmed death-ligand 1.

IF PROGRESSION CONTINUES TO OCCUR

  • Since SCLC is an aggressive cancer, timing is important, along with having a plan for relapsed patients1,21
    • Treatment options depend on what the patient has received prior to relapse, toxicity of treatment, and performance status1
  • Individual patient characteristics also play a role in creating a personalized treatment regimen1,2
    • The field of SCLC research has seen notable progress in understanding tumor biology and malignant progression and developing new strategies for treatment1,2,22

PATIENT CONSIDERATIONS IN DETERMINING SUBSEQUENT THERAPIES1,2

PATIENT CONSIDERATIONS
Performance Status Clipboard Drawing
PERFORMANCE
STATUS 0-2
LATER-LINE
TREATMENT OPTIONS
Subsequent systemic therapy or palliative
symptom management including localized RT is recommended1
Performance Status Clipboard Drawing
PERFORMANCE
STATUS 3-4
Palliative symptom management is recommended1
Small Cell Lung Cancer (SCLC) Brain Metastases Drawing
BRAIN
METASTASES
Radiation options at the time of brain metastases after PCI may be considered in carefully selected patients1
Drawing Of A Family
QUALITY
OF LIFE
Short-term and long-term adverse effects of treatment should be considered, as well as symptomatic benefit of treatment2

Relapse is common. To manage care, appropriate patients may need to move to second-line treatment. It is critical to consider the patient performance status and appropriate treatment options available, and to monitor for early signs of relapse.1,2,5,6

Explore a treatment option

►

Consider all of your treatment options
as you manage small cell lung cancer.1

NCCN=National Comprehensive Cancer Network® (NCCN®)

    REFERENCES:
  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Small Cell Lung Cancer V.3.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed December 21, 2022. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  2. Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021;7(1):3. doi:10.1038/s41572-020-00235-0
  3. Wakuda K, Miyawaki T, Miyawaki E, et al. Efficacy of second-line chemotherapy in patients with sensitive relapsed small-cell lung cancer. In Vivo. 2019;33(6):2229-2234.
  4. Owonikoko TK, Behera M, Chen Z, et al. A systematic analysis of efficacy of second-line chemotherapy in sensitive and refractory small cell lung cancer. J Thorac Oncol. 2012;7(5):866-872. doi:10.1097/JTO.0b013e31824c7f4b
  5. Data on file. LUR-2020-054. Palo Alto, CA: Jazz Pharmaceuticals, Inc.
  6. Data on file. LUR-2020-026. Palo Alto, CA: Jazz Pharmaceuticals, Inc.
  7. Gong J, Salgia R. Managing patients with relapsed small-cell lung cancer. J Oncol Pract. 2018;14(6):359-367.
  8. Oronsky B, Reid TR, Oronsky A, Carter CA. What's new in SCLC? A review. Neoplasia. 2017;19(10):842-847.
  9. Stahel R, Thatcher N, Früh M, et al. 1st ESMO Consensus Conference in lung cancer; Lugano 2010: small-cell lung cancer. Ann Oncol. 2011;22(9):1973-1980.
  10. Etoposide [package insert]. Deerfield, IL: Bristol-Myers Squibb Company: 2017.
  11. Carboplatin [package insert]. Princeton, NJ: Bristol-Myers Squibb Company: 2010.
  12. Cisplatin [package insert]. Princeton, NJ: Bristol-Myers Squibb Company: 2010.
  13. Etoposide FDA-Approved Drugs. FDA. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=018768. Accessed August 1, 2021.
  14. Etoposide [package insert]. Deerfield, IL: Bristol-Myers Squibb Company: 2002.
  15. Tecentriq [package insert]. San Francisco, CA: Genentech Inc, A Member of the Roche Group: 2020.
  16. FDA approves atezolizumab for extensive-stage small cell lung cancer. FDA. https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-atezolizumab-extensive-stage-small-cell-lung-cancer. Accessed March 12, 2021.
  17. Durvalumab [package insert]. Wilmington, DE: AstraZeneca: 2017.
  18. FDA approves durvalumab for extensive-stage small cell lung cancer. FDA. https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-durvalumab-extensive-stage-small-cell-lung-cancer. Accessed August 1, 2021.
  19. Topotecan [package insert]. Research Triangle Park, NC: GlaxoSmithKline: 2007.
  20. Subbiah V, Paz-Ares L, Besse B, et al. Antitumor activity of lurbinectedin in second-line small cell lung cancer patients who are candidates for re-challenge with the first-line treatment. Lung Cancer. 2020;150:90-96.
  21. Huber RM, Tufman A. Update on small cell lung cancer management. Breathe. 2012;8(4):315-330.
  22. Kim D-W, Kim K-C, Kim K-B, Dunn CT, Park K-S. Transcriptional deregulation underlying the pathogenesis of small cell lung cancer. Transl Lung Cancer Res. 2017;7(1):4-20.