Guests/Speakers
Dr. Jacob Sands, Thoracic Oncologist and Associate Chief of the Thoracic Oncology Group, Dana-Farber Cancer Institute
Maida Mangiameli, Voices of Hope Speakers Bureau member and living with extensive-stage small cell lung cancer
For decades, progress in small cell lung cancer (SCLC) was almost non-existent. When host Maida Mangiameli was diagnosed, there wasn’t even a chemotherapy developed specifically for her cancer type. Her oncologist used regimens built for other cancers. In this episode, Maida sits down with Dr. Jacob Sands, Associate Chief of the Thoracic Oncology Group at Dana-Farber Cancer Institute, to talk about the small cell lung cancer treatment advances finally changing that.
Dr. Sands opens with a striking measure of the shift. At the time of this conversation, he says, there are more promising therapies in SCLC clinical trials than in everything developed and approved before this point, combined. “The field is moving that fast.”
Understanding Limited-Stage vs. Extensive-Stage SCLC
Maida asks Dr. Sands to walk through how SCLC staging works. He explains that while stage 1 through 4 classifications exist, SCLC is more often described as limited stage or extensive stage.
Stage 1, a single small nodule with no lymph node involvement, can be treated with surgery, followed by chemotherapy and immunotherapy. But most people with limited-stage disease have more than a nodule. The defining question, Dr. Sands says, is whether the disease fits safely within one radiation field. If it does, that’s limited stage, and it can be treated with a goal of cure: chemotherapy and radiation together, followed by two years of immunotherapy. Extensive stage means the cancer has spread further.
Why Immunotherapy Changed the Conversation
Immunotherapy wasn’t approved for SCLC when Maida went through treatment. Dr. Sands confirms what changed. Adding immunotherapy after chemoradiation has increased long-term disease control and improved survival for limited-stage patients, a shift that simply didn’t exist a decade ago.
Dispelling Clinical Trial Myths
One of the episode’s most important moments comes when Dr. Sands takes on two fears he hears often in clinic.
The first: that enrolling in a trial means you’ve run out of other options. Not true. Many SCLC trials are first-line, for people who haven’t started any treatment yet, and they typically add a promising new therapy on top of the current standard of care.
The second: “I don’t want to end up on a placebo.” No one, he says, would ever receive a placebo alone. Some studies include a placebo, but always as standard of care plus a new drug, or standard of care plus placebo.
He also reframes what a trial is for. Trials aren’t only about helping future patients. For someone diagnosed today, the real question is whether a drug currently in trials might be a better option than today’s standard of care. That’s why he urges every newly diagnosed patient to get a consultation at an academic center that runs multiple SCLC trials, preferably with an oncologist who treats a high volume of small cell lung cancer patients.
Ready to explore your options? Search for a clinical trial that may be right for you.
Why Speed Matters in Small Cell Lung Cancer
Because SCLC grows rapidly, Dr. Sands is direct: don’t wait a month to start treatment. He gives listeners the exact language to use when calling an academic center for a consult.
“I have small cell lung cancer. I have not yet gotten treatment. And my understanding is I need to be seen urgently.”
Naming a scheduled treatment start date helps get you in faster. And options can narrow once treatment has already begun.
He’s equally clear that living your life still counts. He describes a patient he saw in clinic that morning, weighing a rare weekend with all of her children against her treatment start. “These things that seem like they get in the way sometimes, they’re the things that we live for.” The point isn’t to refuse those moments. It’s to understand the risk before you choose.
Maida knows the trade-off firsthand. Told she would start treatment in two weeks, she asked whether she could wait until January for a long-planned cruise along the coast of Australia. Her oncologist said absolutely not.
“Do I credit him with saving my life? Absolutely.”
Screening matters here, too. Dr. Sands notes that because SCLC grows faster than non-small cell lung cancer, low-dose CT screening catches fewer cases at stage 1, but it still finds the majority at limited stage, when treatment can be given with a goal of cure.
Reasons for Hope
Asked point-blank whether SCLC has hit a turning point, Dr. Sands doesn’t take the easy answer. He celebrates the advances, then names the limit:
“Anytime I hit a limit to what I can do… it’s a constant reminder that we’re not there yet.”
He describes being “consumed by how do we get everyone” to long-term disease control, and until that happens, the work continues “as aggressively as possible.”
The hope he does offer is specific. He has patients diagnosed with metastatic small cell lung cancer whom he’s been seeing since before he had children. Those appointments have become, in his words, “really fun social visits years in.” Some tell him there are days they forget they have lung cancer at all, something he calls “unimaginable at the time of diagnosis.”
Maida offers her own evidence. She opens the conversation as “a proud eight-year survivor of extensive stage small cell lung cancer,” and closes it with the proof: her granddaughter was one year old at her diagnosis. She’s nine now.
“I am living proof that there are reasons for hope even when you’re diagnosed with extensive stage small cell.”
You are not alone in this. Connect with LCFA’s Living With Lung Cancer resources and community.
Curious how SCLC treatment has evolved? See the full research update and FDA-approved treatment timeline on our Small Cell Lung Cancer page.
Want the full breakdown of SCLC staging and treatment protocols? Review Small Cell Lung Cancer treatment overview.
