Dr Halmos on the Challenges of Diagnosing SCLC

"The real issue is that SCLC typically is not diagnosed [at] an early stage. We've seen major advances in terms of lung cancer screening…but sadly, SCLC doesn't fall into that group where the screening makes a difference, [as it is] simply just too rapidly developing."

Balazs Halmos, MD, professor, Department of Oncology (Medical Oncology), professor, Department of Medicine (Oncology & Hematology), associate director, Clinical Science, Montefiore Einstein Comprehensive Cancer Center, discusses challenges associated with the diagnosis and treatment of patients with small cell lung cancer (SCLC).

SCLC is challenging to address, primarily because it is rarely diagnosed at an early stage, Halmos begins. Unlike non–small cell lung cancer, SCLC does not significantly benefit from lung cancer screening programs, such as low-dose CT scans, he notes. Although these programs have improved early detection for other types of lung cancer, SCLC progresses too rapidly to be effectively caught in screening intervals, Halmos explains. This aggressive nature underscores the difficulty of early diagnosis, leaving most patients to present with advanced symptomatic disease.

At diagnosis, patients typically fall into one of two categories: limited-stage disease or extensive-stage disease, Halmos continues. Limited-stage disease offers the potential for curative treatment, but these cases often involve bulky nodal disease, making definitive therapy challenging, he says. More frequently, patients are diagnosed with extensive-stage disease, characterized by widespread metastases, severely limitingtreatment options, Halmos notes.

Recent years have brought some progress into the treatment landscape of SCLC, but these advancements have yet to substantially alter overall survival outcomes, Halmos says. The disease remains highly resistant to treatment over time, with most patients eventually experiencing disease progression. This underscores the pressing need for innovative therapies to improve outcomes in both early and advanced stages, Halmos emphasizes.