This activity is for healthcare professionals outside the UK.

This activity is provided by an independent medical education grant from AstraZeneca.

The activity is jointly provided by USF Health and touchIME.

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Lung Cancer, Immunotherapy CE/CME ACCREDITED Watch Time: 39 mins

touchMDT Where to next in limited-stage small cell lung cancer? The role of immune checkpoint inhibitors

A multidisciplinary team discusses the role of immune checkpoint inhibitors (ICIs) in limited-stage small cell lung cancer (LS-SCLC).

 Overview & Learning Objectives
Patient with LS-SCLC
  • What is the rationale for using immune checkpoint inhibitors in LS-SCLC?
    Pulmonologist and radiation oncologist
    Play Arrow Watch Video

    Watch a pulmonologist and a radiation oncologist discuss the rationale for using ICIs in LS-SCLC, including relevant evidence from clinical trials in LS-SCLC and extended-stage SCLC, and review the novel and emerging late-phase ICIs for LS-SCLC.

    Time: 13:21
    Dr Hendriks, Prof. Senan
    Play Arrow Watch Video
  • What are the key data for immune checkpoint inhibitors in the treatment of LS-SCLC?
    Medical oncologist and radiation oncologist
    Play Arrow Watch Video

    Watch a medical oncologist and a radiation oncologist discuss the latest data for ICIs in LS-SCLC, including data released at key congresses in 2024, and share their clinical insights.

    Time: 12:21
    Dr Sands, Prof. Senan
    Play Arrow Watch Video
  • What impact could immune checkpoint inhibitors have on the management of patients with LS-SCLC?
    Radiation oncologist, pulmonologist and medical oncologist
    Play Arrow Watch Video

    Watch a radiation oncologist, a pulmonologist and a medical oncologist discuss the impact of ICIs on the treatment landscape for LS-SCLC, including guidance on patient and ICI selection and the monitoring for and management of immune-related side effects.

    Time: 13:34
    Prof. Senan, Dr Hendriks, Dr Sands
    Play Arrow Watch Video

Expert Spotlight

Dr Lizza Hendriks
Maastricht University Medical Center, Maastricht, The Netherlands
Prof. Suresh Senan
Amsterdam University Medical Center, Amsterdam, The Netherlands

Dr Lizza Hendriks and Prof. Suresh Senan discuss the rationale for using ICIs in LS-SCLC.

Get the Audio Version

Tutorial

This icon indicates there is a poll question. Click it when you see it to interact with your peers.

Poll

How confident are you in explaining the rationale for combining ICIs with radiotherapy in LS-SCLC?

Submit your answer to see the results

Very confident
   
Confident
   
A little confident
   
Not confident
   
Pulmonologist and radiation oncologist
Get the Audio Version
What is the rationale for using immune checkpoint inhibitors in LS-SCLC?
Time: 13:21
Dr Hendriks, Prof. Senan

Watch a pulmonologist and a radiation oncologist discuss the rationale for using ICIs in LS-SCLC, including relevant evidence from clinical trials in LS-SCLC and extended-stage SCLC, and review the novel and emerging late-phase ICIs for LS-SCLC.

Watch Next
Medical oncologist and radiation oncologist

What are the key data for immune checkpoint inhibitors in the treatment of LS-SCLC?

Watch Now

Expert Spotlight

Dr Jacob Sands
Dana-Farber Cancer Institute, Boston, MA, USA
Prof. Suresh Senan
Amsterdam University Medical Center, Amsterdam, The Netherlands

Dr Jacob Sands and Prof. Suresh Senan discuss the key data from 2024 on the use of ICIs in LS-SCLC.

Get the Audio Version

Tutorial

This icon indicates there is a poll question. Click it when you see it to interact with your peers.

Poll

How familiar are you with the latest data for ICI treatment in LS-SCLC?

Submit your answer to see the results

Very familiar
   
Familiar
   
A little familiar
   
Not familiar
   
Medical oncologist and radiation oncologist
Get the Audio Version
What are the key data for immune checkpoint inhibitors in the treatment of LS-SCLC?
Time: 12:21
Dr Sands, Prof. Senan

Watch a medical oncologist and a radiation oncologist discuss the latest data for ICIs in LS-SCLC, including data released at key congresses in 2024, and share their clinical insights.

Watch Next
Radiation oncologist, pulmonologist and medical oncologist

What impact could immune checkpoint inhibitors have on the management of patients with LS-SCLC?

Watch Now

Expert Spotlight

Prof. Suresh Senan
Amsterdam University Medical Center, Amsterdam, The Netherlands
Dr Lizza Hendriks
Maastricht University Medical Center, Maastricht, The Netherlands
Dr Jacob Sands
Dana-Farber Cancer Institute, Boston, MA, USA

Prof. Suresh Senan, Dr Lizza Hendriks and Dr Jacob Sands discuss the clinical impact of ICIs in LS-SCLC.

Get the Audio Version

Tutorial

This icon indicates there is a poll question. Click it when you see it to interact with your peers.

Poll

For how long after their last ICI dose do you monitor patients for immune-related AEs?

Submit your answer to see the results

<3 months
   
<6 months
   
≤12 months
   
>12 months
   
Radiation oncologist, pulmonologist and medical oncologist
Get the Audio Version
What impact could immune checkpoint inhibitors have on the management of patients with LS-SCLC?
Time: 13:34
Prof. Senan, Dr Hendriks, Dr Sands

Watch a radiation oncologist, a pulmonologist and a medical oncologist discuss the impact of ICIs on the treatment landscape for LS-SCLC, including guidance on patient and ICI selection and the monitoring for and management of immune-related side effects.

Watch Next
Pulmonologist and radiation oncologist

What is the rationale for using immune checkpoint inhibitors in LS-SCLC?

Watch Now
Back To Top
Overview & Learning Objectives
Overview

In this activity, a multidisciplinary team, including a pulmonologist, a medical oncologist and a radiation oncologist, shares its perspectives on the rationale for using ICIs in LS-SCLC, the key data for ICIs in the treatment of LS-SCLC, and the impact of ICIs on the management of patients.

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

Target Audience

Oncologists (including lung cancer specialists), radiation oncologists, pulmonologists, thoracic surgeons and oncology nurses involved in the management of patients with LS-SCLC.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 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 Lizza Hendriks discloses: Advisory board or panel fees from Amgen, Anheart, AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Lilly, Merck, MSD, Novartis, Pfizer and Takeda. Grants/research support from AbbVie, Amgen, AstraZeneca, Blueprint, Boehringer Ingelheim (relationship terminated), Gilead, GSK, Merck, Mirati, MSD, Novartis, Pfizer, Roche Genentech and Takeda. Other financial or material support (royalties, patent, etc.) from Secretary NVALT studies foundation and Subchair EORTC metastatic NSCLC systemic therapy. Speaker’s bureau fees from AstraZeneca, Bayer, Benecke, GSK, High5 Oncology, Janssen, Lilly, MSD, Pfizer, Sanofi and Takeda.

Dr Jacob Sands discloses: Consultancy fees from AbbVie, Amgen, AstraZeneca, Daiichi Sankyo, G1 Therapeutics, Guardant, Lilly, Medtronic, Merck, Pharma Mar and Sanofi (all relationships terminated).

Prof. Suresh Senan discloses: Advisory board or panel fees from AstraZeneca, BMS, MSD and Varian Medical Systems. Grants/research support from AstraZeneca.

Content reviewer

Carolina Leon BSN, MSN, ARNP-BC, nurse reviewer and planner, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

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

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 0.75 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 0.75 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 0.75 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 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 18 November 2024. Date credits expire: 18 November 2025.

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

Learning Objectives

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

  • Evaluate the potential role of immune checkpoint inhibitors in the treatment of patients with limited-stage small cell lung cancer
  • Recall the latest data for ICIs in LS-SCLC
  • Examine the possible impact of ICIs on the management of patients with LS-SCLC
Faculty & Disclosures
Dr Lizza Hendriks

Maastricht University Medical Center, Maastricht, The Netherlands

Dr Lizza Hendriks is a pulmonologist specializing in lung cancer at Maastricht University Medical Center, The Netherlands, where she leads the Clinical Lung Cancer Research Department. Her main interest is in brain metastases in patients with lung cancer, obtaining a PhD on this topic in 2016. read more

Dr Hendriks leads the Innovative Cancer Diagnostics Therapy group at the School for Oncology and Developmental Biology (GROW) at Maastricht University and is (local) principal investigator in several phase II and III clinical trials, focusing on (locally) advanced NSCLC and SCLC, targeted treatments and immunotherapies. She is an active member of Dutch (Dutch Society of Pulmonology [NVALT] and the Tuberculosis and Netherlands Respiratory Society), European (European Organisation for Research and Treatment of Cancer [EORTC], European Respiratory Society, European Society for Medical Oncology [ESMO] and the European Thoracic Oncology Platform) and global societies (American Society of Clinical Oncology and the International Association for the Study of Lung Cancer). Dr Hendriks is secretary of the NVALT studies foundation and chairs the EORTC sub-committee on Systemic Treatment for Metastatic NSCLC. She is a member of national and ESMO guideline committees and is a programme committee member or chair of several international conferences. She is a member of the Young Academy of the Royal Netherlands Academy of Arts and Sciences.

Dr Lizza Hendriks discloses: Advisory board or panel fees from Amgen, Anheart, AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Lilly, Merck, MSD, Novartis, Pfizer and Takeda. Grants/research support from AbbVie, Amgen, AstraZeneca, Blueprint, Boehringer Ingelheim (relationship terminated), Gilead, GSK, Merck, Mirati, MSD, Novartis, Pfizer, Roche Genentech and Takeda. Other financial or material support (royalties, patent, etc.) from Secretary NVALT studies foundation and Subchair EORTC metastatic NSCLC systemic therapy. Speaker’s bureau fees from AstraZeneca, Bayer, Benecke, GSK, High5 Oncology, Janssen, Lilly, MSD, Pfizer, Sanofi and Takeda.
Dr Jacob Sands

Dana-Farber Cancer Institute, Boston, MA, USA

Dr Jacob Sands is a thoracic oncologist at the Dana-Farber Cancer Institute, Boston, MA, USA, who specializes in treating lung cancer and conducts clinical and translational work in lung cancer diagnostics and treatment. read more

Dr Sands leads a National Cancer Institute-sponsored adjuvant non-small cell lung cancer (NSCLC) study with planned enrolment of >1,200 patients, is a co-author of manuscripts that have changed the SCLC paradigm, including lurbinectedin and tarlatamab, as well as a lead author and presenter of datopotamab deruxtecan for NSCLC. He is also a co-founder and president of the Rescue Lung Society, a non-profit medical society focused on advancing lung screening.

Dr Jacob Sands discloses: Consultancy fees from AbbVie, Amgen, AstraZeneca, Daiichi Sankyo, G1 Therapeutics, Guardant, Lilly, Medtronic, Merck, Pharma Mar and Sanofi (all relationships terminated).
Prof. Suresh Senan

Amsterdam University Medical Center, Amsterdam, The Netherlands

Professor Suresh Senan is a radiation oncologist at the Amsterdam University Medical Center in The Netherlands. read more

His research has focused on trials of systemic agents and radiation for lung malignancies, new radiotherapy techniques and studying population outcomes. He is a faculty member for thoracic malignancies at the European Society of Medical Oncology and the International Association for the Study of Lung Cancer.

Prof. Suresh Senan discloses: Advisory board or panel fees from AstraZeneca, BMS, MSD and Varian Medical Systems. Grants/research support from AstraZeneca.
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This activity is funded by:

an independent medical education grant from AstraZeneca and 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 judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

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 to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME activities. touchIME accepts no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 18 November 2024. Date credits expire: 18 November 2025.

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Question 1/5
How would you describe the preclinical rationale for combining RT and ICIs to treat lung cancer?

ICI, immune checkpoint inhibitor; RT, radiotherapy; TME, tumour microenvironment.
 Correct

Early clinical evidence has hinted at a synergy between RT and immunotherapy. RT induces irreversible DNA damage and tumour cell death, stimulating the release of tumour antigens into the TME, which are engulfed by antigen-presenting cells. This upregulates immunogenic surface markers and cross-presentation of the tumour antigens to T cells. Cell-mediated immunity is activated and more lymphocytes are recruited to target distant tumour cells, which may elicit an abscopal effect.1

The reprogrammed TME induced by RT can transform ‘cold’ tumours with poor immune cell infiltration into ‘hot’ tumours with lymphocytic infiltration, providing a prerequisite for response to ICIs.2

Abbreviations
ICI, immune checkpoint inhibitor; RT, radiotherapy; TME, tumour microenvironment.

References

  1. Cheng SH, et al. Oncol Rep. 2024;52:96.
  2. Zhang Z, et al. Signal Transduct Target Ther. 2022;7:258.
Question 2/5
When discussing with colleagues, how would you describe the efficacy and safety of adjuvant durvalumab vs placebo in patients with LS-SCLC who had not progressed following first-line cCRT reported in the ADRIATIC trial? “Compared with placebo, patients who received durvalumab experienced…”

cCRT, concurrent chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; m, median; OS, overall survival; PFS, progression-free survival.
 Correct

The phase III ADRIATIC trial is investigating the use of durvalumab ± tremelimumab vs placebo as an adjuvant treatment in patients with LS-SCLC who had not progressed after first-line cCRT. Results from the data cutoff on 15 January 2024 demonstrated a significantly longer mOS and mPFS in the durvalumab arm (n=264) vs placebo (n=266) (mOS: 55.9 vs 33.4 months [p=0.01]; mPFS: 16.6 vs 9.2 months [p=0.02]).

Pneumonitis or radiation pneumonitis occurred in 38.2% of patients in the durvalumab arm and 30.2% in the placebo arm, with grade 3/4 pneumonitis or radiation pneumonitis occurring in 3.1% and 2.6%, respectively.

Abbreviations
cCRT, concurrent chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; m, median; OS, overall survival; PFS, progression-free survival.

Reference
Cheng Y, et al. N Engl J Med. 2024;391:1313–27.

Question 3/5
How would you describe the difference in mOS of patients with LS-SCLC who received CRT plus atezolizumab vs CRT alone in the NRG-LU005 trial?

CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; mOS, median overall survival.
 Correct

The phase III NRG-LU005 trial is investigating the use of CRT plus atezolizumab followed by atezolizumab maintenance (n=274) vs CRT alone (n=270) in patients with LS-SCLC. Data from an interim analysis (median follow-up 21.0 months) reported a mOS of 33.1 months in the atezolizumab plus CRT arm vs 39.5 months in the CRT alone arm (p=0.7640).

Abbreviations
CRT, chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; mOS, median overall survival.

Reference
Higgins KA, et al. Presented at: 2024 ASTRO Annual Meeting, Washington, DC, USA. 20 September–2 October 2024. Abstr. LBA02.

Question 4/5
Your patient with LS-SCLC has not progressed after definitive cCRT. Assuming local approval and availability, you discuss initiating durvalumab treatment with your patient and they ask you how long they can expect to remain on treatment if no complications arise. Based on clinical trial designs and guideline recommendations, what would you advise?

cCRT, concurrent chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer.
 Correct

In the ADRIATIC trial, patients with LS-SCLC were randomized to receive durvalumab, durvalumab plus tremelimumab or placebo after cCRT until investigator-determined progression or unacceptable toxicity, or for a maximum of 24 months.1

The most recent NCCN guidelines state that durvalumab is the preferred regimen for consolidation therapy in patients with LS-SCLC who have not experienced disease progression after systemic therapy plus concurrent radiotherapy. Treatment is recommended until disease progression, unacceptable toxicity or for a maximum of 24 months.2

Abbreviations
cCRT, concurrent chemoradiotherapy; LS-SCLC, limited-stage small cell lung cancer; NCCN, National Comprehensive Cancer Network.

References

  1. Cheng Y, et al. N Engl J Med. 2024;391:1313–27.
  2. NCCN Clinical Practice Guidelines in Oncology. Small Cell Lung Cancer Version 3.2025 — October 29, 2024. Available at: NCCN.org (accessed 4 November 2024).
Question 5/5
Your patient with LS-SCLC is enrolled in a clinical trial with an ICI and either concurrent or sequential CRT and has developed pneumonitis. What would you do to determine the pneumonitis aetiology?

CRT, chemoradiotherapy; ICI, immune checkpoint inhibitor; LS-SCLC, limited-stage small cell lung cancer.
 Correct

It is important to distinguish between RT-pneumonitis and IR-pneumonitis,1-3 as the aetiology has potential implications in directing clinical management, including corticosteroid dose and the decision to restart or indefinitely discontinue ICI treatment.1,3

Evidence from NSCLC suggests that both RT- and IR-pneumonitis often manifest as ground-glass opacities and consolidations on CT imaging.1 RT-pneumonitis is usually, but not always, contained within the portion of the lung covered by the radiation field.2-4 IR-pneumonitis tends to be bilateral, involving more lobes of the lung,1,3 with consolidations and opacities not specifically located within the radiation field.1,2

Bronchoscopy with bronchoalveolar lavage is another diagnostic test to confirm pneumonitis aetiology.4

Abbreviations
CT, computed tomography; ICI, immune checkpoint inhibitor; IR, immune-related; NSCLC, non-small cell lung cancer; RT, radiotherapy.

References

  1. Chen X, et al. Oncologist. 2021;26:e1822–32.
  2. Smesseim I, et al. Radiother Oncol. 2024;194:110147.
  3. Wang P, et al. Int Immunopharmacol. 2024;128:111489.
  4. Naidoo J, et al. Clin Lung Cancer. 2020;21:e435–44.
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