EP. 6: Key Takeaways From IMforte for Clinicians Treating ES-SCLC

Ticiana Leal, MD Winship Cancer Institute of Emory University | Stephen Liu, MD Georgetown Lombardi Comprehensive Cancer Center | Isabel Preeshagul, DO, MBS Memorial Sloan Kettering Cancer Center | Rahul Gosain, MD, MBA Wilmot Cancer Institute | Rohit Gosain, MD Roswell Park Comprehensive Cancer Center

Key Points

• Lurbinectedin plus atezolizumab was approved for maintenance therapy in the first-line setting for untreated extensive-stage small cell lung cancer (ES-SCLC).

• This regimen is the third approval in the first-line setting and the first maintenance regimen for this patient population.

• Use of a maintenance approach should be discussed before initiating treatment with patients to guide shared and informed decision making.

IMforte Takeaways for Lurbinectedin Maintenance in ES-SCLC

On the Oncology Brothers podcast, three thoracic oncologists shared their perspectives on the pivotal phase 3 IMforte trial that led to the approval of lurbinectedin plus atezolizumab as maintenance therapy for patients with ES-SCLC in the first-line setting. 

The IMforte maintenance regimen is a notable advancement that builds upon previous research on immunotherapy and sequencing in first-line treatment of ES-SCLC, said Isabel Preeshagul, DO, MBS, of Memorial Sloan Kettering Cancer Center. “[These] data [are] exciting; we always worry about relapse in maintenance, but if we have something proven to prolong progression-free survival and overall, I think it’s a regimen to consider for the right patient using shared and informed decision making,” Dr. Preeshagul said.

Stephen Liu, MD, of Georgetown Lombardi Cancer Center, an author on the IMforte trial, addressed potential concerns with using lurbinectedin as a maintenance therapy instead of saving it for relapsed or refractory patients. Attrition is substantial in the SCLC space, and less than half of patients go on to receive any second-line therapy. “If we wait until progression, many patients won’t start any second line therapy despite approved options because the act of progression itself can be fatal or make patients too sick,” Dr. Liu said.

“This is an important gain for patients with SCLC,” said Ticiana Leal, MD, of Winship Cancer Institute of Emory University. Dr. Leal emphasized the need to review this regimen before even starting induction so patients know what to expect and can make informed decisions. “I think for the majority of patients, this is a treatment we are going to be discussing, and I think patients are going to be interested in it,” she added.