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Bridging the Gaps in Lung Cancer 

Erminia Massarelli, MD, PhD, MS, co-director, Lung Cancer and Thoracic Oncology Program, associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope, discusses unmet needs in the treatment of patients with small cell lung cancer (SCLC) that were discussed at the 2023 Bridging the Gaps in Lung Cancer meeting, as well as how further research may help mitigate these needs.

One gap in care hindering advances in SCLC treatment is the lack of individually tailored research and therapies for the 2 main types of SCLC: SCLC in former or current smokers, and SCLC in never-smokers. The latter subtype usually arises as a transformation from a molecularly driven disease, such as 

-mutated non–small cell lung cancer, Massarelli says. These 2 categories of SCLC differ from each other, and thus require different testing and treatment considerations, Massarelli notes. Molecular testing is crucial in never-smokers with transformed SCLC, as it can reveal targetable drivers of disease, Massarelli emphasizes. Although molecular testing may also be useful in patients with smoker-driven SCLC, the advantages of identifying molecular drivers and potential targeted treatment options in this patient subset remain unclear, Massarelli explains.

Another important gap in the management of patients with SCLC is the lack of effective therapies in this population, according to Massarelli. The progress in this area over the past 30 years has been minimal, Massarelli says. One of the most recent FDA approvals of an immunotherapy for patients with SCLC was the 2019 

accelerated approval of pembrolizumab (Keytruda) monotherapy in patients with metastatic disease

 who had progressed on at least 2 prior lines of therapy, including 1 line of platinum-based chemotherapy. Several clinical trials led by academic institutions and pharmaceutical companies are ongoing to address the need for more SCLC treatment options, Massarelli notes. Patients with SCLC are encouraged to participate in these trials, which may lead to the discovery of novel targets and treatments, Massarelli concludes.

Erminia Massarelli, MD, PhD, MS, discusses unmet needs in the treatment of patients with small cell lung cancer that were discussed at the 2023 Bridging the Gaps in Lung Cancer meeting, as well as how further research may help mitigate these needs.

Dr Massarelli on Addressing Unmet Needs in SCLC

Edward S. Kim, MD, MBA, physician-in-chief, City of Hope Orange County, vicephysician-in-chief, City of Hope National Medical Center, discusses the importance of the Bridging the Gaps in Lung Cancer meeting, and expands on the importance of educating clinicians on how to best implement new developments within lung cancer to address these gaps in care.

The Bridging the Gaps in Lung Cancer meeting was created to identify, discuss, and prioritize, current disparities in the treatment of patients with lung cancer, Kim begins. The meeting considered the challenges and limitations associated with care in clinical practice across the spectrum of race, gender, socioeconomic status, and locality. Potential strategies for prevention were also discussed, Kim adds.

Areas for improvement that were identified at the meeting will be prioritized in next year's session, and strategies to address these inequalities will also be discussed, Kim states. Additionally, meeting organizers hope to publish the conclusions and recommendations reached at this year’s meeting, Kim notes. Sharing this information with colleagues and the public may accelerate the work that needs to be done to close these gaps in care and improve patient outcomes, he says.

Experts in lung cancer are also focused on how to effectively share this knowledge with colleagues across community practices, Kim continues. The field of lung cancer is dynamic and approaches to treatment have greatly advanced in recent years with shifts in biomarker classification and the identification of new disease subtypes, Kim details. Precision medicine approaches have also gained significant traction in non–small-cell lung cancer through the introduction of biomarker-driven therapy, Kim states. However, many eligible patients do not fully benefit from these treatments because of existing limitations in utilizing predictive biomarkers. Additionally, some patients develop resistance to TKIs and immunotherapy, which can negatively affect their outcomes.

Up to this point, individualized treatment has been predominantly utilized in the metastatic setting, but innovation in this space has begun to move these strategies into earlier disease stages, Kim says. Accordingly, there is a greater emphasis on ensuring correct, prompt, and comprehensive evaluation and treatment of patients. Guidelines on how to best diagnosis, treat, and care for these patients are therefore vital to ensuring optimal patient benefit, Kim concludes.

Edward S. Kim, MD, MBA, discusses the importance of the Bridging the Gaps in Lung Cancer meeting, and expands on the importance of educating clinicians on how to best implement new developments within lung cancer to address these gaps in care. 

Bridging the Gaps in Lung Cancer | Conference

Dr Massarelli on Addressing Unmet Needs in SCLC

Dr Kim on the Bridging the Gaps in Lung Cancer Meeting