SCS01: Advancing Outcomes in Limited-Stage Small Cell Lung Cancer: From Evidence to Practice-Case Discussion: Practical Applications of Evidence

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The case discussion by Dr. Erminia Massarelli focuses on the practical application of evidence in treating a 71-year-old male with a history of heavy smoking, who has been diagnosed with stage IIIA small cell carcinoma in the right upper lobe of the lung. The patient's pre-existing conditions include hypertension, hyperlipidemia, and type 2 diabetes mellitus. Family history reveals that his father and uncle also died from lung cancer.<br /><br />Initial imaging showed a mass in the right upper lobe and lymphadenopathy. Pathology confirmed small cell carcinoma with metastases in lymph nodes. The treatment plan included chemoradiation therapy using cisplatin and etoposide, and an intensity-modulated radiation therapy (IMRT) consisting of 60 Gy in 30 fractions. <br /><br />Referring to the ADRIATIC Trial data, benefits of different radiation schedules and platinum agents were discussed. The trial showed better overall survival (OS) rates with the use of durvalumab, a type of immunotherapy, especially when coupled with carboplatin instead of cisplatin, irrespective of whether the radiation was given once daily (QD) or twice daily (BID). Additionally, prophylactic cranial irradiation (PCI) showed a modest survival benefit but was not universal.<br /><br />Post-treatment imaging demonstrated a reduction in tumor size and lymphadenopathy. The medical team faced decisions regarding durvalumab maintenance therapy, imaging follow-ups, duration for durvalumab administration, and considerations for PCI. The potential impact of adverse events, such as radiation-induced pneumonitis, on the decision to start durvalumab was also considered.<br /><br />Finally, the ADRIATIC Trial findings indicated a notable OS benefit when patients received durvalumab, both with and without the inclusion of PCI, emphasizing careful consideration of individual patient factors in clinical practice.

Asset Subtitle

Erminia Massarelli

Keywords

small cell carcinoma

chemoradiation therapy

ADRIATIC Trial

durvalumab

immunotherapy

prophylactic cranial irradiation

radiation-induced pneumonitis

stage IIIA lung cancer

cisplatin

carboplatin