Here is a glimpse at updated clinical trial data on newer therapies under study for the small cell lung cancer (SCLC) and advanced extrapancreatic neuroendocrine tumors.
IMpower133 and ALTER: Novel Therapies for SCLC
Martin Reck, MD, PhD
The treatment of small cell lung cancer has seen little progress in recent years, but based on studies reported at the European Society for Medical Oncology Congress, this could be changing. The long-term follow-up of the phase III IMpower133 trial confirmed atezolizumab plus chemotherapy as a new front-line standard in advanced disease.1 The updated analysis, performed after 2 years of follow-up, found median overall survival to be 12.3 months with front-line atezolizumab/chemotherapy vs 10.3 months with carboplatin plus etoposide alone (hazard ratio [HR] = 0.76; P = .0154), according to Martin Reck, MD, PhD, of the Lung Clinic Grosshansdorf in Germany.
IMpower133 is the first trial in the front-line setting of SCLC to demonstrate a significant improvement in survival since the introduction of platinum-based chemotherapy in the 1990s. Exploratory biomarker analyses showed a benefit with the addition of the checkpoint inhibitor regardless of biomarker status and a consistent benefit across subgroups.
As a later line of therapy, updated analysis of the multicenter, randomized, double-blind phase II ALTER trial found a striking benefit for the multitarget tyrosine kinase inhibitor anlotinib in 120 patients with previously treated relapsed SCLC.2 Anlotinib significantly prolonged not only progression-free survival (4.1 vs 0.7 months; HR = 0.19; P < .0001), but also overall survival (7.3 vs 4.9 months; HR = 0.53; P = .0029), reported Ying Chen, MD, of Jilin Cancer Hospital in Changchun, China.
SANET-ep: Surufatinib in Neuroendocrine Tumors
Jianming Xu, MD
The phase III SANET-ep trial of the small-molecular multikinase inhibitor surufatinib was halted early after meeting its primary endpoint, as reported by Jianming Xu, MD, of The Fifth Medical Center, General Hospital of the People’s Liberation Army, Beijing.3 The oral agent was evaluated in a phase III Chinese study of 198 patients with well-differentiated, progressive, unresectable or metastatic extrapancreatic neuroendocrine tumors.
Median progression-free survival was 9.2 in the surufatinib arm vs 3.8 months with placebo (HR = 0.334; P < .0001). A parallel study of surufatinib in pancreatic neuroendocrine tumors is ongoing.
DISCLOSURE: Dr. Reck has served as a consultant or advisor for or served on the speakers bureaus of, Roche, Lilly, Pfizer, Boehringer Ingelheim, AstraZeneca, Bristol-Myers Squibb, Merck, Novartis, AbbVie, MSD, Lilly, and Celgene. Dr. Xu reported no conflicts of interest.
1. Reck M, Liu SV, Mansfield AS, et al: IMpower133: Updated overall survival analysis of first-line atezolizumab + carboplatin + etoposide in extensive-stage SCLC. ESMO Congress 2019. Abstract 1736O. Presented September 28, 2019.
2. Chen Y, Wang Q, Li K, et al: Overall survival update in ALTER 1202: Anlotinib as third-line or further-line treatment in relapsed small-cell lung cancer. ESMO Congress 2019. Abstract 1738O. Presented September 28, 2019..
3. Xu J, Shen L, Zhou Z, et al: Efficacy and safety of surufatinib in patients with well-differentiated advanced extrapancreatic neuroendocrine tumors: Results from the randomized phase III study (SANET-ep). ESMO Congress 2019. Abstract LBA76. Presented September 29, 2019.