Akshit Chitkara, MD

Big update in extensive-stage SCLC. DeLLphi-305 showed that adding tarlatamab to durvalumab maintenance improved median OS from 12.7 to 21.1 months and PFS from 1.9 to 7.4 months, measured from maintenance randomization. These are impressive results, and I can see this changing our maintenance discussions with patients. I’m still thinking through two questions. First, where does this leave lurbinectedin + atezolizumab maintenance from IMforte? The DeLLphi-305 numbers look better, but we cannot establish superiority by comparing results across trials. Second, what do we give after progression on tarlatamab + durvalumab? Trials, platinum rechallenge in selected patients, and lurbinectedin/topotecan are considerations, but we need better evidence in patients whose disease has progressed on tarlatamab. Keeping tarlatamab for second line is an understandable argument. In clinic, though, we also see patients deteriorate too quickly to receive the next treatment. One detail I’d particularly want to examine is how many patients in the control arm received tarlatamab after progression. That matters when discussing early treatment versus reserving it for relapse. I’m encouraged by these results. Alongside working out the best sequence, we’ll need to make treatment accessible and have the staffing, monitoring and caregiver support to deliver it safely. nejm.org/doi/full/10.1056/NE… #ESMO26 #LCSM #SCLC @UVMcancercenter @myESMO @lcfamerica @SclcSMASHERS

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