The future of small cell lung cancer care


Small cell lung cancer is the least common
form of lung cancer that we treat It makes up approximately 15% of lung cancer. Patients who present with
small cell lung cancer tend to have large primary tumours
and large lymph nodes within their chest. As a consequence of those large
volume tumours and lymph nodes, they suffer with cough and
breathlessness and often chest pain. The survival from small cell lung cancer is unfortunately
much worse than non-small cell lung cancer even with standard of care treatment
they only survive 10 months. As a consequence, there’s very few
patients who live to 5 years. The challenge that I face when I treat
patients with small cell lung cancer is that the cancer itself grows quickly. The majority of patients that I treat
have advanced incurable disease. As a consequence of that, I typically use
combination chemotherapy. When I first meet patients with extensive-stage
small cell lung cancer, I explain to them that their disease is likely
to respond well to chemotherapy In fact, many of those patients are impressed
when they see the response they’ve had to their platinum doublet chemotherapy. Unfortunately though, many of them are
devastated when they come back only after a short period of time later
to find their disease has regrown and on receiving further treatment
does not respond as well as it did. For over 20 years, combination chemotherapy
has been the standard of care. Despite over 40 clinical trials, there hasn’t yet been
any significant change to that standard of care. When you combine chemotherapy
with immunotherapy you’re combining a treatment which can
gain control of the disease quickly. The immunotherapy is then allowed time to mount an immune response
which offers the patient durability. It’s now recognised that tumours
with high mutational burden are the ones that respond best to
immunotherapy drug treatment. Small cell lung cancer is
just one of those tumours. As a consequence of that, when patients with
small cell lung cancer receive immunotherapy, the immunotherapy encourages their
immune system to attack their tumour cells. Over the past 10 years, there have been
dramatic developments in the management of patients
with lung cancer. Through advances in our
understanding of lung cancer, we’ve seen new drugs such as immunotherapy,
new types of chemotherapy, new targeted therapy but also advances in
radiation delivery and even surgery. Patients with extensive-stage small cell
have disease which grows quickly. You therefore need treatment which can gain
control of the disease quickly, As with most new treatments that we see in oncology,
we examine their benefits in the advanced setting. I’m hopeful that in future, those benefits will be examined
in the limited stage setting of small cell lung cancer Now, patients who I treat with lung cancer
have a wealth of new treatment options, and it’s important that we personalise
those treatment options to their disease.