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    Faculty & Disclosures
    Dr Anne Chiang

    Yale School of Medicine, New Haven, CT, USA

    Dr Anne Chiang is an associate professor of medicine in the section of Medical Oncology and the Associate Cancer Center Director, Clinical Initiatives, both at Yale School of Medicine in Connecticut, USA. read more

    Dr Chiang has a background in translational research in metastasis, as well as extensive experience in clinical practice in both academic and community settings. She specializes in thoracic oncology and her clinical focus has been on building a small cell lung cancer programme at Yale, with a comprehensive portfolio of clinical trials testing novel therapeutics for these patients. Her research interests focus on the development of clinical trials and translational studies to test novel agents and combinations with immune checkpoint inhibitors, for both small cell and non-small cell lung tumours.

    Dr Chiang has served as Deputy Chief Medical Officer and Chief Integration Officer for Smilow Cancer Hospital (SCH), having helped to build the SCH Network and oversee operations, quality efforts and clinical research in 15 Smilow Care Centers. She has a particular focus on quality measurement and improvement and has spearheaded quality initiatives locally and nationally for the American Society of Clinical Oncology.

    Dr Anne Chiang discloses: Advisory board or panel fees from AstraZeneca, Daiichi Sankyo, Genentech and Janssen. Grants/research support from AbbVie, Amgen, Bristol Myers Squibb and Genentech.
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    Focus Questions
    What are the current standard-of-care treatments for LS-SCLC, particularly considering the role of chemotherapy and radiotherapy?
    What are the NCCN and ESMO guideline recommendations for treating LS-SCLC? Are there other guidelines to be aware of?
    What are the NCCN and ESMO guideline recommendations for treating LS-SCLC? Are there other guidelines to be aware of?
    What evidence supports the current combined chemoradiotherapy regimen used for LS-SCLC?
    What evidence supports the current combined chemoradiotherapy regimen used for LS-SCLC?
    What treatment outcomes would you expect when managing a patient with LS-SCLC using concurrent chemotherapy and radiotherapy?
    What treatment outcomes would you expect when managing a patient with LS-SCLC using concurrent chemotherapy and radiotherapy?
    What role does surgery have in the treatment of LS-SCLC?
    What role does surgery have in the treatment of LS-SCLC?
    What are the remaining unmet treatment needs for patients with LS-SCLC?
    What are the remaining unmet treatment needs for patients with LS-SCLC?
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    Current treatments and unmet needs in limited-stage small cell lung cancer

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    Dr Anne Chiang is an associate professor of medicine in the section of Medical Oncology and the Associate Cancer Center Director, Clinical Initiatives, both at Yale School of Medicine in Connecticut, USA. read more

    Dr Chiang has a background in translational research in metastasis, as well as extensive experience in clinical practice in both academic and community settings. She specializes in thoracic oncology and her clinical focus has been on building a small cell lung cancer programme at Yale, with a comprehensive portfolio of clinical trials testing novel therapeutics for these patients. Her research interests focus on the development of clinical trials and translational studies to test novel agents and combinations with immune checkpoint inhibitors, for both small cell and non-small cell lung tumours.

    Dr Chiang has served as Deputy Chief Medical Officer and Chief Integration Officer for Smilow Cancer Hospital (SCH), having helped to build the SCH Network and oversee operations, quality efforts and clinical research in 15 Smilow Care Centers. She has a particular focus on quality measurement and improvement and has spearheaded quality initiatives locally and nationally for the American Society of Clinical Oncology.

    Dr Anne Chiang discloses: Advisory board or panel fees from AstraZeneca, Daiichi Sankyo, Genentech and Janssen. Grants/research support from AbbVie, Amgen, Bristol Myers Squibb and Genentech.

    Faculty Podcast Featured
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Describe the current treatment landscape for limited-stage small cell lung cancer
    • Discuss the unmet treatment needs for patients with limited-stage small cell lung cancer
    Overview

    In this interview, Dr Anne Chiang answers a series of questions on the current standard-of-care treatments for limited-stage small cell lung cancer (LS-SCLC), and highlights the remaining unmet treatment needs for patients.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    This activity has been designed to meet the educational needs of oncologists, including lung cancer specialists, oncology nurses, radiation oncologists, pulmonologists and thoracic surgeons involved in the management of LS-SCLC.

    Disclosures

    All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr Anne Chiang discloses: Advisory board or panel fees from AstraZeneca, Daiichi Sankyo, Genentech and Janssen. Grants/research support from AbbVie, Amgen, Bristol Myers Squibb and Genentech.

    Content reviewer

    Carolina Leon, BSN, MSN, ARNP-BC has no relevant financial relationships to disclose.

    Touch Medical Contributors

    Katrina Lester has no financial interests/relationships or affiliations in relation to this activity.

    Joanne Morton discloses: Employee or independent contractor relationship with OPEN Health Communications, LLP (relationship terminated).

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.5 credit hours AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 0.5 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded 0.5 ANCC pharmacotherapeutic contact hour.

    Date of original release: 24 April 2024. Date credits expire: 24 April 2025.

    If you have any questions regarding credit please contact cpdsupport@usf.edu

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    This activity is funded by:

    An independent medical education grant from AstraZeneca.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside of the UK only.

    Date of original release: 24 April 2024. Date credits expire: 24 April 2025.

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    Current treatments and unmet needs in limited-stage small cell lung cancer
    0.5 CE/CME credit
    Question 1/5
    You are discussing RT regimens with your patient with newly diagnosed LS-SCLC who is due to start cisplatin/etoposide treatment the following week. Your patient expresses their concern about attending clinic BID to receive RT. How would you counsel this patient?

    BID, twice daily; LS-SCLC, limited-stage small cell lung cancer; QD, once daily; RT, radiotherapy.

    NCCN and ESMO guidelines recommend concurrent CRT for patients with LS-SCLC, with RT commencing on the first or second cycle of chemotherapy.1,2 ESMO and ASTRO guidelines recommend that patients with LS-SCLC receive 45 Gy RT BID. However, these guidelines state that 60–70 Gy QD is an acceptable RT regimen if BID RT is not feasible.2,3 In clinical practice, there is a lack of consensus regarding the routine use of BID RT,2 and many patients receive QD RT instead.4

    Abbreviations

    ASTRO, American Society for Radiation Oncology; BID, twice daily; CRT, chemoradiotherapy; ESMO, European Society for Medical Oncology; LS-SCLC, limited-stage small cell lung cancer; NCCN, National Comprehensive Cancer Network; QD, once daily; RT, radiotherapy.

    References

    1. NCCN. Small Cell Lung Cancer v2.2024. Available at https://bit.ly/3TE40XM (accessed 08 February 2024).
    2. Dingemans A-MC, et al. Ann Oncol. 2021;32:839–53.
    3. Simone CB, et al. Pract Radiat Oncol. 2020;10:158–73.
    4. Bogart J, et al. J Clin Oncol. 2023;41:2394–402.
    Question 2/5
    Your patient with stage IIA LS-SCLC has undergone extensive pathological mediastinal staging and no nodal disease has been detected (T1, N0, M0). Which of the following treatment options would you consider to best manage this patient?

    CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; M, metastasis; N, node; T, tumour.

    NCCN and ESMO guidelines recommend surgery within the context of a multimodal treatment approach for patients with stage I–IIA (T1–2, N0, M0) LS-SCLC. Extensive pathological mediastinal staging is required to rule out nodal disease prior to surgery. The aim of surgery is for a complete resection and sublobular resection is not recommended. Intraoperative systematic nodal dissection is advisable to inform subsequent treatment. Postoperative adjuvant chemotherapy is recommended after surgical resection for patients without nodal disease.1,2

    Abbreviations

    ESMO, European Society for Medical Oncology; LS-SCLC, limited-stage SCLC; M, metastasis; N, node; NCCN, National Comprehensive Cancer Network; T, tumour.

    References

    1. NCCN. Small Cell Lung Cancer v2.2024. Available at https://bit.ly/3TE40XM (accessed 19 March 2024).
    2. Dingemans A-MC, et al. Ann Oncol. 2021;32:839–53.
    Question 3/5
    In the phase III CONVERT trial, how did long-term median OS compare between the 66 Gy QD and the 45 Gy BID RT treatment arms?

    BID, twice daily; OS, overall survival; QD, once daily; RT, radiotherapy.

    The phase III CONVERT trial (NCT00433563) was designed to show superiority of 66 Gy QD RT compared with a 45 Gy BID RT regimen in patients with LS-SCLC receiving concurrent cisplatin/etoposide.1,2 Long-term data (median follow-up of 81.2 months) presented at ELCC 2024 showed that median OS was similar between RT arms: 25 months for patients treated with 66 Gy QD and 30 months for patients treated with 45 Gy BID (HR for death, 1.13; 95% CI 0.92–1.38; P=0.247). At 5 years, 32% and 34% were alive, respectively.2,3

    Abbreviations

    BID, twice daily; CI, confidence interval; ELCC, European Lung Cancer Congress; HR, hazard ratio; LS-SCLC, limited-stage small cell lung cancer; OS, overall survival; QD, once daily; RT, radiotherapy.

    References

    1. Faivre-Finn C, et al. Lancet Oncol. 2017;18:1116–25. 
    2. Walls GM, et al. Int J Radiat Oncol Biol Phys. 2024;S0360-3016(24)00382-1. doi: 10.1016/j.ijrobp.2024.02.063.
    3. Walls G, et al. Presented at: ELCC Congress 2024, Prague, Czech Republic. 20–23 March 2024. Abstract 193MO.
    Question 4/5
    You are discussing treatment options with your 73-year-old patient with newly diagnosed LS-SCLC. Your patient asks what side effects to expect with concurrent vs sequential CRT. Based on available clinical data, what would you tell them?

    CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer.

    Randomized controlled trials and a retrospective analysis suggest that in patients with LS-SCLC, concurrent CRT may be associated with more severe haematological toxicities compared with sequential CRT.1-3 Even though the proportion of patients ≥70 years old diagnosed with SCLC is increasing, their under-representation in clinical trials (comprising ~13–21% of trial populations) means there is limited evidence supporting the optimal treatment of these patients.4 

    Abbreviations

    CRT, chemoradiotherapy; LS-SCLC, limited-stage SCLC; SCLC, small cell lung cancer.

    References

    1. Takada M, et al. J Clin Oncol. 2002;20:3054–60.
    2. Zhao J, et al. J Cancer. 2020;11:4957–64. 
    3. Wang Z, et al. Cancer Control. 2020;27:1073274820956619. doi: 10.1177/1073274820956619.
    4. Killingberg KT, et al. J Thorac Oncol. 2023;18:803–12.
    Question 5/5
    When mentoring a newly qualified colleague on the current treatment options for LS-SCLC they ask why novel therapies may be beneficial. How would you best summarize the current unmet treatment needs for patients?

    CNS, central nervous system; CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; PCI, prophylactic cranial irradiation.

    There are a number of unmet treatment needs for patients with LS-SCLC. Despite initial CRT response rates of up to 90% in patients with disease confined within a single radiation field,1 long-term outcomes remain poor with approximately one-third of patients alive 5 years after starting CRT.1,2 Disease recurrence is high,3 with 90% of relapses occurring within 2 years of treatment.4 Patients surviving >2 years (from the start of treatment) have a high incidence of CNS impairment, which is likely to be independent of PCI.5 

    Abbreviations

    CNS, central nervous system; CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; PCI, prophylactic cranial irradiation.

    References

    1. Punekar SR, Shum E. J Thorac Oncol. 2020;15:1806–8.
    2. Bogart JA, et al. J Clin Oncol. 2022;40:661–70.
    3. Ellis PM, et al. Curr Oncol. 2021;28:2778–88. 
    4. Karacz CM, et al. Clin Lung Cancer. 2020;21:127–35.e3.
    5. PDQ Adult Treatment Editorial Board. 2024. Available at: https://bit.ly/4acueHS (accessed 05 March 2024).
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    This activity is funded by:

    An independent medical education grant from AstraZeneca.
    This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside of the UK only.

    Date of original release: 24 April 2024. Date credits expire: 24 April 2025.

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