Kristie L. Kahl: What are the differences between small cell and non-small cell lung cancer?
Andrew Ciupek: One of the main differences is that non-small cell lung cancer is the most common type. So, about 70% of patients will be diagnosed with non-small cell, which makes small cell itself much rarer — about 20% to 30% of patients.
One of the other main differences is in the way that they grow. You could say that small cell is a more aggressive form of lung cancer. It tends to grow faster and spread to other parts of the body more quickly. Also, there are differences in the ways they are treated. But those are the main differences.
Kristie L. Kahl: With treatment, where are we right now?
Andrew Ciupek: Compared to non-small cell lung cancer, the treatment options for small cell are a bit more limited. One of the mainstays of therapy for small cell lung cancer is chemotherapy. That is because small cell lung cancer actually responds well to initial chemotherapy treatment because it’s faster-growing, chemotherapy works better against it. We’ve started to see that change a little bit.
In the last year or two, we’ve started to see approvals in immunotherapy, especially in combination with other treatments for small cell (lung cancer). Although the treatment options are still less, we’re starting to see an increase.
Kristie L. Kahl: What is exciting in the field of small cell lung cancer right now?
Andrew Ciupek: The exciting thing is that a lot of the researchers have recognized there is a real area of need here because there are limited treatment options in small cell (lung cancer). There are a lot of clinical trials that are looking at new ways to treat it. They’re falling into a lot of areas, so we’re seeing exciting things.
One of the most exciting is immunotherapy, which was thought for a while not to work really well in small cell (lung cancer), has actually gone through clinical trials and we’ve had the first approvals for immunotherapy combinations in the past year or two for small cell (lung cancer).
So, we’re starting to see immunotherapies that have worked really well for non-small cell (lung cancer) to help small cell lung cancer patients, too. That is a sign of things to come. As we keep doing clinical trials, we’ll see more therapeutic options coming in addition to those we already have, making them better, and new therapies that can help patients.
Kristie L. Kahl: What are some clinical trial options that patients have right now?
Andrew Ciupek: I like to say that clinical trials are particularly important for small cell lung cancer patients because right now, compared to non-small cell (lung cancer) and other types, we have fewer approved therapies. A lot of the cutting-edge and main therapies that we are following will be available through clinical trials. That is why it’s always important to have a conversation about that with your doctor.
We’re seeing a lot of trends. One, now that the first immunotherapy has become available for small cell lung cancer, we’re looking at ways of making it better. Can we combine it with chemotherapy, which we already know works well for small cell lung cancer? Can we combine it with other drugs that help it work for more patients? We’re also looking at better ways to use chemotherapy. We know chemotherapy and small cell lung cancer work together. So, we’re trying to see if we can combine chemotherapies together or with other drugs.
Although we don’t have any targeted therapy approvals yet, like we do for non-small cell lung cancer, there are a few clinical trials that are looking at certain mutations or changes in small call (lung cancer) that may be unique and may lead to the future of targeted therapy approvals.
There is a lot to be excited about because there is a lot of research going on because we do recognize this is an area of need.
Kristie L. Kahl: What are ways patients can learn more about these trials?
Andrew Ciupek: The first way is to start by having that conversation with your doctor. They know a lot about your medical history and often there are clinical trials available right at the clinic or hospital you are already being treated at and they can help direct you to that if they know that is something you’re interested in and help you have that conversation.
Now, there is an increase in the amount of resources to help patients find out more about clinical trials because they often have to do research on their own. One of the mainstays is clinicaltrials.gov, which all clinical trials are required to be recorded there. But the results can often be hard for patients to navigate. There’s a lot of information, and you don’t really know which treatment is better than another.
There are a lot of other resources starting to form. One is online resources. A lot of patients have formed communities online, both via social media and also on patient forums, to share information on clinical trials with each other and to keep up with that.
The patient advocacy organizations can be a great resource, too. For instance, (the Go2 Foundation for Lung Cancer) has a program called Lung Match, where we can actually have people call our help line (1800-298-2436) or email us at firstname.lastname@example.org, and connect with a navigator — someone like myself or someone else on the team.
What we can help do, is once we find out more about your story, we can generate a list of personalized clinical trials for you and help come up with good questions you might want to ask your doctor at your next appointment. So, there are a lot of resources and going out there, in addition to connecting with your doctor, and doing your own research has become easier. We still realize it’s a daunting task.
Kristie L. Kahl: What is on the horizon for patients with small cell lung cancer?
Andrew Ciupek: What we’re going to start to see is more therapeutic options. One of the real difficult parts of small cell (lung cancer) is that we just haven’t seen the same amount of approvals and advancement compared to non-small cell lung cancer. We have a lot to look forward to. We’re starting to see this change.
A lot of people thought initially that immunotherapy wouldn’t work as well for small cell lung cancer patients, but we’re finding out that there are some patients that might work really well for.
We’re turning a corner, and I think that’s why it’s really important as a small cell lung cancer patient right now to keep an eye out and have conversations about clinical trials. That is where a lot of this is going to emerge, and I think there is a lot of reason to be hopeful because of the number of clinical trials that are going on. To include that in your conversation, I hope we’ll continue to see more approvals and options come out.
Transcription edited for clarity.