Patient Profile 2: A 60-Year-Old Man with SCLC Progressing on First-Line Therapy

Charu Aggarwal, MD, MPH: We'll turn over to a case now. Vivek, you have a case of a patient with second-line and subsequent treatment of small-cell lung cancer.

Vivek Subbiah, MD: This is a 60-year-old male, a former smoker with a past medical history of diabetes mellitus type 2, hypertension, and with no family history of cancer. A patient presented with shortness of breath and increasing fatigue, and this was during COVID time. The COVID test was done. The COVID test was negative. And patient continues to have shortness of breath. The workup revealed, initially, a CT scan was done, showed bilateral lung metastasis. And MRI brain was done, and it was negative for metastasis. A biopsy revealed small blue round cell tumors and confirmed as small cell lung cancer. And the NGS [next generation sequencing] testing was also sent out by both tissue biopsy and liquid biopsy showed a p53 mutation. And in our frontline, since the patient presented before the CASPIAN and IMpower study that out was treated with cisplatin and etoposide. And patient had a nice response. Patient had a nice response over 6 months. And follow-up after frontline therapy receding scans showed new lesions in the bone and new lesions in the right lung. Again, the ECOG performance was maintained at 1. MRI brain, again, showed no brain lesions. And this patient was started on second-line treatment on lurbinectedin at a dose of 3.2 mg per meter squared flat dose and administered intravenously once every 3 weeks. The patient tolerated therapy reasonably well. And the adverse events for the patient was anemia grade 1, thrombocytopenia grade 1, and patient had numbness and tingling, neuropathy grade 1, and nausea grade 1. And follow-up after lurbinectedin restaging scan after 2 months showed early response to therapy to the new lung lesion, stable disease in the bones, and stable primary disease. Again, unfortunately for this patient, the MRI brain continued to be negative for metastasis. Patient continued lurbinectedin at the same dose at the flat dose as the patient tolerated therapy reasonably well. And because the bone met was stable and to help with the bone prophylaxis, denosumab was added to the management of this patient. The adverse effects were the same. Patient continues to have anemia grade 1, thrombocytopenia grade 1, neutropenia grade 1, and numbness and tingling, neuropathy grade 1. Restaging scans after another 2 months showed continued reduction of the new lesions. And, a decreased ability of the bone lesions. This time a PET CT scan was done, and MRI brain continued to be negative for this patient.

Transcript lightly edited for clarity.