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Lung Cancer CE/CME ACCREDITED Watch Time: 38 mins

touchMDT Continuing the momentum in SCLC: Exploring second-line and novel therapy options

MDT specialists discuss the current and emerging second-line treatment options for patients with extensive-stage small cell lung cancer (ES-SCLC)

 Overview & Learning Objectives

Patient with relapsed SCLC
Medical Oncologist & Oncology Pharmacist
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Second-line treatment choices for SCLC Dr Barbara Melosky, Dr Sonia Amin Thomas

A medical oncologist and oncology pharmacist discuss the second-line treatment choices for patients with relapsed SCLC and highlight key emerging treatments and combinations in the second-line setting.

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Medical Oncologist & Pulmonologist
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Tailoring treatment choices in relapsed SCLC Dr Barbara Melosky, Dr Christine Argento

A medical oncologist and pulmonologist discuss how side effects of SCLC treatment and patient performance status impact treatment selection and prognosis, and the potential for molecular classification to determine future treatment options.

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Medical Oncologist, Oncology Nurse Practitioner & Oncology Pharmacist
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Adverse event management in SCLC Dr Barbara Melosky, Dr Victoria Sherry, Dr Sonia Amin Thomas

A medical oncologist, oncology nurse practitioner and oncology pharmacist discuss the management strategies for patients with relapsed SCLC experiencing treatment side effects and consider how to balance clinical effectiveness with patient quality of life.

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Medical Oncologist & Oncology Pharmacist

A medical oncologist and oncology pharmacist discuss the second-line treatment choices for patients with relapsed SCLC and highlight key emerging treatments and combinations in the second-line setting.
Expert Spotlight
Dr Barbara Melosky
University of British Columbia, Vancouver, Canada
Dr Sonia Amin Thomas
Wellstar North Fulton Hospital and Northwest Georgia Oncology Center, Roswell, GA, USA

Dr Barbara Melosky and Dr Sonia Amin Thomas discuss the clinical assessment and current treatment choices for a patient with relapsed SCLC and highlight key emerging treatments and combinations in the second-line setting.

Listen on the Go

 Learn more Back to MDT Hub Time: 11:24
 
Medical Oncologist & Pulmonologist

A medical oncologist and pulmonologist discuss how side effects of SCLC treatment and patient performance status impact treatment selection and prognosis, and the potential for molecular classification to determine future treatment options.
Expert Spotlight
Dr Barbara Melosky
University of British Columbia, Vancouver, Canada
Dr Christine Argento
Johns Hopkins School of Medicine, Baltimore, MD, USA

Dr Barbara Melosky and Dr Christine Argento discuss how side effects of SCLC treatment and patient performance status impact treatment selection and prognosis. They speculate how molecular classification of SCLC and predictive biomarkers might be useful for determining treatment options in the future.

Listen on the Go

 Learn more Back to MDT Hub Time: 13:36
 
Medical Oncologist, Oncology Nurse Practitioner & Oncology Pharmacist

A medical oncologist, oncology nurse practitioner and oncology pharmacist discuss the management strategies for patients with relapsed SCLC experiencing treatment side effects and consider how to balance clinical effectiveness with patient quality of life.
Expert Spotlight
Dr Barbara Melosky
University of British Columbia, Vancouver, Canada
Dr Victoria Sherry
Abramson Cancer Center, Hospital of the University of Pennsylvania, PA, USA
Dr Sonia Amin Thomas
Wellstar North Fulton Hospital and Northwest Georgia Oncology Center, Roswell, GA, USA

Dr Barbara Melosky, Dr Victoria Sherry and Dr Sonia Amin Thomas discuss the clinical assessment and management strategies for a patient with SCLC experiencing treatment side effects. They consider the side effects profiles of the current treatment options in the second-line setting and how to balance clinical effectiveness with patient quality of life.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:51
 
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Overview & Learning Objectives
Overview

In this activity, a medical oncologist, oncology pharmacist, pulmonologist, and oncology nurse practitioner share their insights on the current therapeutic strategies for patients with relapsed small cell lung cancer (SCLC), how treatment options are tailored to each individual patient, and how patient outcomes can be optimized through improved adverse event management in the second-line treatment setting.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists, pulmonologists, pharmacists and specialist oncology nurses involved in the management of SCLC.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Barbara Melosky discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Jazz Pharmaceuticals, Merck, Novartis, Pfizer and Roche.

Dr Sonia Amin Thomas has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Christine Argento discloses: Advisory board or panel fees from Biodesix. Consultancy fees from Biodesix, Boston Scientific, Cook Medical, Intuitive Surgical and Olympus Therapeutics.

Dr Victoria Sherry discloses: Consultancy fees from AstraZeneca and Boehringer Ingelheim.

Content reviewer

Anand Shah, Pharm D, BCOP discloses: Advisory board or panel fees from EMD Serono, Pharmacosmos (relationships terminated). Speakers Bureau fees from Exelixis. Stock/Shareholder (self-managed) with Cardiff Oncology.

Alicia Canalejo, MSN, ARNP-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Pharmacists

USF Health is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This knowledge-based program has been approved for 0.75 contact hours (0.75 CEUs).  Universal program number is as follows: 0230-9999-23-001-H01-P.

Date of original release: 19 January 2023. Date credits expire: 19 January 2024.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Describe the current and emerging second-line treatment options for patients with SCLC
  • Identify patient- and disease-related factors that affect treatment decisions for patients with SCLC in the second-line setting
  • Describe strategies to manage adverse events for patients with SCLC in the second-line treatment setting
Faculty & Disclosures
Dr Barbara Melosky

University of British Columbia, Vancouver, Canada

Barbara Melosky, MD, FRCPC, is a clinical professor of medicine at the University of British Columbia and a medical oncologist at the BC Cancer Center in Vancouver. Dr Melosky specializes in thoracic malignancies and is chair of the Lung Tumor Group at the BC Cancer Center in British Columbia. read more

Dr Melosky sits on the Executive Lung Site Committee for Canadian Cancer Trials Group (CTTG). For the past 18 years, she has chaired the annual Canadian Lung Cancer Conference, attended by over 450 participants.

She is proud to have founded the British Columbia Lung Cancer Biobank, which is actively used for research.

Dr Melosky has published extensively and is considered a national and international expert in thoracic malignancies.

Dr Barbara Melosky discloses: Advisory board or panel fees from AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Jazz Pharmaceuticals, Merck, Novartis, Pfizer and Roche.
Dr Sonia Amin Thomas

Wellstar North Fulton Hospital and Northwest Georgia Oncology Center, Roswell, GA, USA

Sonia Amin Thomas, PharmD, BCOP is an associate professor of pharmacy practice at the PCOM-Georgia School of Pharmacy and a clinical oncology specialist at Wellstar North Fulton Hospital in Georgia. read more

She attended the University of Georgia for her undergraduate coursework and then proceeded to complete her PharmD at South University School of Pharmacy. Dr Thomas completed a postgraduate year one general pharmacy practice residency in Columbus, Georgia, and received training through a postgraduate year two oncology residency in Detroit, Michigan.

At the PCOM-Georgia School of Pharmacy, she teaches the oncology therapeutics module, clinical reasoning and pharmacogenomics. At Wellstar North Fulton Hospital, she precepts fourth year advanced pharmacy practice experience (APPE) students and postgraduate year one residents on an outpatient/inpatient oncology rotation. She attends a clinic at Northwest Georgia Oncology Centers (NGOC). She is also a graduate of the Institute for Integrative Nutrition (IIN) and a health and wellness nutrition coach for cancer survivors.

Dr Sonia Amin Thomas has no interests/relationships or affiliations to disclose in relation to this activity.
Dr Christine Argento

Johns Hopkins University, Baltimore, MD

Christine Argento, MD, is an associate professor of medicine at The Johns Hopkins University in Maryland where she specializes in interventional pulmonology. read more

Dr Argento graduated from St. George’s University School of Medicine in Grenada, completed an internal medicine residency at the University of Medicine and Dentistry in New Jersey, a pulmonary and critical care fellowship at Yale University in Connecticut, and an additional fellowship in interventional pulmonology at Duke University, North Carolina.

Her main focus is on the diagnosis and palliation of patients with lung cancer and evaluation of pulmonary nodules and pleural disease. Her research involves new technologies that further the field of interventional pulmonology, increasing awareness of lung cancer and lung cancer screening, as well as disparities in lung cancer and procedural simulation education.

She is vice president of the Association of Interventional Pulmonary Program Directors (AIPPD), and is a founding and board member of Women in Interventional Pulmonology (WiIP). She also holds leadership roles in national societies such as CHEST and American Thoracic Society (ATS), as well as the American Association of Bronchial and Interventional Pulmonology (AABIP).

Dr Christine Argento discloses: Advisory board or panel fees from Biodesix. Consultancy fees from Biodesix, Boston Scientific, Cook Medical, Intuitive Surgical and Olympus Therapeutics.
Dr Victoria Sherry

Abramson Cancer Center, Hospital of the University of Pennsylvania, PA, USA

Victoria Sherry, DNP, CRNP, ANP-BC, AOCNP, is an adult oncology nurse practitioner for thoracic malignancies at the Abramson Cancer Center at the University of Pennsylvania (UPenn). Dr Sherry is also an advanced senior lecturer at the UPenn School of Nursing where she teaches both undergraduate and graduate students. read more

She earned her bachelor of science in nursing degree at the Catholic University of America, Washington, D.C. and received her master of science in nursing degree at UPenn, from which she graduated as an adult oncology nurse practitioner. She went on to obtain her doctor of nursing practice from Duke University in North Carolina, where her dissertation focused on distress screening and management in patients with metastatic lung cancer.

Dr Sherry is a member of the Oncology Nursing Society (ONS) and the Philadelphia Area Chapter of the ONS. She is also a member of the Xi Chapter of Sigma Teta Thau International Honor Society of Nursing, and the International Thoracic Oncology Nursing Forum (ITONF).

Dr Victoria Sherry discloses: Consultancy fees from AstraZeneca and Boehringer Ingelheim.
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This Activity Is Funded By:

An independent medical education grant from Jazz Pharmaceuticals and is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 19 January 2023. Date credits expire: 19 January 2024.

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Question 1/5
Your patient with ES-SCLC has received four cycles of atezolizumab + carboplatin + etoposide and a PET/CT scan shows stable disease. When discussing ongoing treatment options, they mention having heard about the IMforte trial and ask for more information. You tell them that the phase III IMforte trial is assessing lurbinectedin in combination with which agent(s) and in which setting?

CT, computerized tomography; ES-SCLC, extensive-stage small cell lung cancer; PET, positron emission tomography.
 Correct

IMforte (NCT05091567) is an ongoing multicentre, open-label, randomized, controlled phase III trial to assess and compare the efficacy and safety of lurbinectedin in combination with atezolizumab versus atezolizumab alone administered as maintenance therapy in patients with ES-SCLC who received first-line atezolizumab + carboplatin + etoposide treatment. The co-primary endpoints are progression-free survival and overall survival. Estimated study completion is March 2026.

Abbreviation

ES-SCLC, extensive-stage small cell lung cancer.

Reference

ClinicialTrials.gov. NCT05091567. Available at: https://beta.clinicaltrials.gov/study/NCT05091567 (accessed 7 December 2022).

Question 2/5
Three months after completing primary therapy with atezolizumab + platinum chemotherapy + etoposide for ES-SCLC, your 65-year-old male patient has relapsed while receiving maintenance atezolizumab. His performance status remains 1 and no metastases have been identified. Based on current guideline recommendations, which treatment would you now choose for this patient?

ES-SCLC, extensive-stage small cell lung cancer.
 Correct

Patients who relapse within 6 months of completing primary platinum-based therapy for the treatment of SCLC are considered to have ‘platinum-resistant’ disease; those who have a durable tumour response of more than 6 months are considered to have ‘platinum-sensitive’ disease.1,2 For patients who relapse within 6 months of completing first-line therapy, current guidelines from the National Comprehensive Cancer Network© SCLC Panel recommend topotecan, lurbinectedin, or a clinical trial; for patients who relapse after 6 months or more, guidelines recommend rechallenging with the original regimen.2 Guidelines discourage the use of immune checkpoint inhibitors in patients who progress while on maintenance atezolizumab or durvalumab.2

Abbreviation

SCLC, small cell lung cancer.

References

  1. Das M, et al. Adv Ther. 2021;38:5431–51.
  2. NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer. Version 1.2023 — August 25, 2022. Available at: http://bit.ly/3TKYq47 (accessed 19 October 2022).
Question 3/5
Based on genomic analyses from the IMpower133 trial, what is the potential implication of the molecular subtype SCLC-I in guiding immunotherapy treatment decisions in patients with ES-SCLC?

ES-SCLC, extensive-stage small cell lung cancer; SCLC-I, small cell lung cancer – inflamed subtype.
 Correct

Compared with the other tumour subtypes, SCLC-I (‘inflamed’ SCLC subtype) has higher expression of immune checkpoint molecules, including PD-L1 and PD-1.1 Gene expression data from the IMpower133 trial demonstrated that patients in the atezolizumab + carboplatin + etoposide arm with SCLC-I tumours had greater median OS (18.2 months) than patients with the ASCL1 (SCLC-A, 10.9 months) and NEUROD1 (SCLC-N, 10.6 months) subtypes. However, similar median OS results were seen in the placebo arm for all three subtypes (SCLC-I, 10.4 months; SCLC-A, 10.6 months; SCLC-N, 9.4 months), suggesting SCLC-I has increased sensitivity to immunotherapy but may not be a prognostic marker.1 Further analysis of IMpower133 data showed that a higher proportion of the SCLC-I subtype group were LTS (patients who survived ≥18 months after randomization) than non-LTS (55% vs 45%); however, LTS were not limited to the SCLC-I group.2 Further research is needed before biomarkers can be actively employed to guide use of immunotherapy in patients with SCLC.2

Abbreviations

ASCL1, achaete-scute family bHLH transcription factor 1; LTS, long-term survivors; NEUROD1, neuronal differentiation 1; OS, overall survival; PD-1, programmed cell death protein 1; PD-L1, programmed death-ligand 1; SCLC, small cell lung cancer.

References

  1. Gay CM, et al. Cancer Cell. 2021;39:346–60.
  2. Liu SV, et al. Presented at: ESMO 2021. 16–21 September 2021. Virtual plenary.
Question 4/5
Your patient with ES-SCLC has been receiving first-line atezolizumab + carboplatin + etoposide therapy. At their clinic follow-up, the patient was found to be febrile and hypoxic. He was admitted due to rapid respiratory decompensation and was diagnosed with grade 4 ICI pneumonitis. What treatments would you consider once the patient is stable but subsequently progresses on his current regimen?

CAV, cyclophosphamide + doxorubicin + vincristine; ES-SCLC, extensive-stage small cell lung cancer; ICI, immune checkpoint inhibitor.
 Correct

ASCO guidelines for the management of immune-related adverse events in patients treated with ICI therapy recommend that, for patients who experience grade 3 or 4 ICI pneumonitis, treatment with an ICI should be permanently discontinued.1 When the patient subsequently progresses, the preferred second-line treatment options recommended by the National Comprehensive Cancer Network© SCLC Panel are topotecan, lurbinectedin or a clinical trial, but other regimens, such as CAV, temozolomide or irinotecan, are also included as recommended second-line options.2

Abbreviations

ASCO, American Society of Clinical Oncology; CAV, cyclophosphamide + doxorubicin + vincristine; ICI, immune checkpoint inhibitor; SCLC, small cell lung cancer.

References

  1. Schneider BJ, et al. J Clin Oncol. 2021;39:4073–126.
  2. NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer. Version 1.2023 — August 25, 2022. Available at: http://bit.ly/3TKYq47 (accessed 19 October 2022).
Question 5/5
Your 60-year-old patient has initiated topotecan for relapsed ES-SCLC and is experiencing fatigue but no other side effects. A chest X-ray was normal. How do you help your patient manage this side effect?

ES-SCLC, extensive-stage small cell lung cancer.
 Correct

ASCO guidelines for supportive care during cancer treatment are based on a systematic review of the literature and expert panel recommendations.1 The guidelines state that oncology providers should recommend aerobic and resistance exercise to patients during active cancer treatment to mitigate side effects of treatment, including fatigue.1 Independent meta-analyses across different cancer types have shown that aerobic and/or resistance exercise during cancer treatment can help to reduce cancer-related fatigue.1–3

Abbreviation

ASCO, American Society of Clinical Oncology.

References

  1. Ligibel JA, et al. J Clin Oncol. 2022;40:2491–507.
  2. Oberoi S, et al. Crit Rev Oncol Hematol. 2018;122:52–9.
  3. Hilfiker R, et al. Br J Sports Med. 2018;52:651–8.
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