Guests/Speakers
Dr. Jacob Sands, Oncologist, Dana-Farber Cancer Institute
Dr. Sands’ Assistant: Courtney Mantz, Program Manager II, SCLC Program
Dana-Farber Cancer Institute, Lowe Center for Thoracic Oncology
Wendy Brooks, Patient Advocate
Changing the Future of Small Cell Lung Cancer
For decades, a small cell lung cancer diagnosis carried one of the most devastating prognoses in oncology. But today, groundbreaking treatments are fundamentally changing the outlook for patients, offering extended survival and improved quality of life that was once unimaginable.
“We had decades of not much changing,” explains Dr. Jacob Sands, thoracic oncologist at Dana-Farber Cancer Institute, “and then around eight years ago is where we saw the first really big change in that the checkpoint inhibitors, a kind of immunotherapy, entered the first line treatment with the initial chemotherapy plus immunotherapy.”
The impact of these advances has been profound. “The magic of that is that there’s a subset of patients that end up with years of ongoing disease control,” Dr. Sands continues. “I have patients that are more than five years out from that initial discussion doing great, living their lives at this point not on treatment, and I’ll go as far as to say that I think there are some patients that are cured of their incurable disease.”
A New Era of Treatment Options
The treatment landscape for small cell lung cancer has expanded dramatically in recent years, with several innovative approaches showing remarkable promise:
T-Cell Engagers
T-cell engagers represent a revolutionary approach to immunotherapy. These treatments work by grabbing immune cells and tumor cells, bringing them together to create a targeted immune response. Tarlatamab (Tarab), a bispecific T-cell engager, received FDA approval last year and has shown impressive results in controlling the disease in some patients.
“This is the first of a whole class of drugs that I anticipate to be part of our treatment algorithms as different options,” notes Dr. Sands. “There are a number of trials right now looking at combinations of T-cell engagers with other drugs as well.”
CAR T-Cell Therapy
CAR T-cell therapy, already standard care for certain blood cancers, is now being adapted for small cell lung cancer. This one-time treatment involves collecting a patient’s own immune cells, processing them to recognize cancer cells, and returning them to the patient to fight the disease.
Dr. Sands explains: “Essentially we hook patients up and pull out some blood, spin it down so that it separates out all the different blood types, and we basically pull off those immune cells. Those immune cells get processed in a way that when we give them back, they’re able to recognize the cells that have DL3, which is very common on small cell lung cancer.”
Antibody Drug Conjugates (ADCs)
ADCs deliver chemotherapy directly to cancer cells, minimizing damage to healthy tissue. “Antibody drug conjugates are compounds with essentially three components,” Dr. Sands describes. “One is the antibody, meaning that it has something that finds a certain receptor and binds to it. When that compound is pulled into the cell, that chemo is released inside the cell and essentially then kills the cell. This really represents an exciting way of delivering chemotherapy right to the tumor instead of just as broadly when we give just chemo.”
The Critical Role of Clinical Trials
For patients like Wendy Brooks, who was diagnosed with small cell lung cancer in July 2023 after a routine lung screening, clinical trials have been life-changing. Contrary to common misconceptions, participating in trials isn’t about being a “guinea pig” but about accessing cutting-edge treatments before they become widely available.
“It was so important for me to be involved in the clinical trial because that gave me the latest and greatest treatment today instead of having to wait for formal approval,” Wendy explains. “You actually get a better standard of care. You’re tested more often, you’re scanned more often, they’re really keeping a close eye on the disease, and if it’s not working, having an opportunity to pivot to another treatment is so critical with the aggressiveness of small cell lung cancer.”
Living with Hope
Perhaps the most significant change in small cell lung cancer care is the genuine sense of hope that now exists for patients. While the disease remains challenging, the rapid pace of research and development means new options are continuously emerging.
Wendy Brooks captures this sentiment perfectly:
“You have to have hope, and you have to not dwell in despair because new treatments are coming around every day, and the research is just so promising on what’s going to be the next best thing. That’s what I would tell folks: don’t dwell in despair, always have hope because you never know when your magic bullet is gonna arrive.”
The Path Forward
For those newly diagnosed with small cell lung cancer, Dr. Sands emphasizes the importance of understanding all available options, including clinical trials. He encourages patients to ask their doctors specific questions about potential treatments and their expected benefits and side effects.
Wendy advises patients to be their own advocates:
“If you’re told that there’s nothing that we can do, there’s no treatment for you, seek a second opinion. It’s so important to reach out to others. Your oncologist, they’re not going to be upset, you’re not going to offend them if you’re reaching out to seek a second opinion. They may even encourage it and help facilitate that for you.”
The transformation in small cell lung cancer treatment represents one of oncology’s most promising developments. While not every patient will experience dramatic results, the possibility of extended survival and improved quality of life is now a reality for many. Through continued research, clinical trials, and patient advocacy, the future holds even more promise for those facing this once nearly insurmountable diagnosis.
Resources:
Learn more about clinical trials for lung cancer
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