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Yale University School of Medicine
Deputy Chief Medical Officer
Chief Network Officer
Smilow Cancer Hopsital
New Haven, Connecticut
Anne Chiang, MD, PhD, has disclosed that she has received consulting fees from AstraZeneca, Genentech/Roche, and Jazz Pharmaceuticals and funds for research support from Amgen, AstraZeneca, Bristol-Myers Squibb, and Stemcentrx.
Over the past 3-4 decades, more than 40 phase III trials have failed to improve upon platinum/etoposide chemotherapy for the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC). In recent years, multiple phase III trials have demonstrated a clinical benefit of adding an anti–PD-L1 immune checkpoint inhibitor (ie, atezolizumab or durvalumab) to chemotherapy for these patients, thereby ushering in a new standard of care in the frontline setting for ES-SCLC. However, not all patients will be candidates for treatment with immunotherapy.
In the relapsed setting, only 2 agents are FDA approved: topotecan, a topoisomerase inhibitor originally approved in 1998, with an oral version approved in 2007, and lurbinectedin, an alkylating drug approved in June 2020 that is indicated for the treatment of adult patients with metastatic SCLC and disease progression on or after platinum-based chemotherapy. Other options recommended by clinical guidelines for the treatment of relapsed disease include single-agent chemotherapies (eg, temozolomide or a taxane) and anti–PD-1 immune checkpoint inhibitor monotherapy (ie, nivolumab and pembrolizumab). However, due to the limited activity of all currently available therapies for relapsed disease, experts recommend enrolling these patients in a clinical trial if available.
To help guide rational treatment selection in this evolving treatment setting, my colleagues and I developed an online decision support tool for ES-SCLC, including newly diagnosed and relapsed disease.
Navigating the Treatment Decision Tool for ES-SCLC
The ES-SCLC treatment decision support tool provides treatment consultation and recommendations from 5 lung cancer experts for 76 defined patient case scenarios in both the newly diagnosed and relapsed/refractory settings. As a user of the tool, you can enter key patient and disease characteristics to define the different patient scenarios for which you are interested (Figure 1).
Figure 1. Entering patient and disease characteristics into the tool.
Once the information for your particular patient scenario has been defined, you will be asked to indicate your intended treatment choice. After entering your treatment choice, you will be shown the individualized treatment recommendations from all 5 experts for that combination of patient and disease characteristics, allowing you to compare them with your intended therapy (Figure 2).
Figure 2. Expert treatment recommendations.
Through this approach, you can identify clinical scenarios where experts agree on the best treatment options and other scenarios where the available supporting evidence does not clearly favor one treatment over others, and consequently, there is more diversity in expert recommendations.
We hope that you will try this tool and find it useful in the care of your patients with ES-SCLC.
The goal is to routinely update this online tool so that our recommendations continue to include consideration of emerging data and newly available agents as they enter the clinic.
If you have any suggestions regarding this online tool, please be sure to leave a comment below.