Small cell lung cancer (SCLC) accounts for approximately 15% of lung cancers, and most patients are diagnosed with extensive-stage disease (ES-SCLC) – a highly deadly and difficult to treat disease.
The new IMforte study, presented at the American Society of Clinical Oncology [ASCO] 2025 annual meeting, published in The Lancet, reports on the first phase 3 trial to identify a clinically significant improvement in survival from ES-SCLC since the introduction of immunotherapy in 2019.
The current recommended first-line treatment for patients includes atezolizumab (an immunotherapy medication) plus carboplatin and etoposide (chemotherapy medications), followed by maintenance immunotherapy treatment.
Lurbinectedin is an alkylating agent that works by slowing or stopping the growth of cancer cells and is approved for the treatment of metastatic SCLC that has progressed on or after chemotherapy.
In this phase 3 trial, researchers evaluated whether the addition of lurbinectedin to standard care would improve progression-free and overall survival in the first-line maintenance setting.
653 patients with ES-SCLC received four 21-day cycles of induction treatment (atezolizumab, carboplatin, etoposide).
After completing induction treatment, eligible patients without disease progression (483 patients) were randomised to receive maintenance treatment with lurbinectedin and atezolizumab or atezolizumab alone.
Compared to patients receiving atezolizumab, patients treated with lurbinectedin plus atezolizumab saw a 46% reduction in the risk of death or progression and a 27% reduction in the risk of death, equivalent to a 22.6-month gain in overall survival, and a 3.3-month gain in progression-free survival.
IS TISSUE THE ISSUE?
Adverse events were higher among patients treated with lurbinectedin (38% vs 22% for Grade 3/4 and 5% vs 3% for Grade 5), likely due to the longer treatment exposure associated with lurbinectedin and the myelosuppressive nature of the drug.
Authors say further research to understand which patients would benefit most from the combination treatment, as well as long-termfollow-upp will be important.
Paper: Paz-Ares, L, et al. Efficacy and safety of first-line maintenance therapy with lurbinectedin plus atezolizumab in extensive-stage small-cell lung cancer (IMforte): a randomised, multicentre, open-label, phase 3 trial. The Lancet. Access online here.
Source: The Lancet
