Tag Archive for: extensive stage SCLC

Small Cell Lung Cancer and Immuno-Oncology | What Patients Need to Know

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Small Cell Lung Cancer and Immuno-Oncology | What Patients Need to Know from Patient Empowerment Network on Vimeo.

What do immuno-oncology advancements mean for limited stage and extensive stage small cell lung cancer (SCLC)? Dr. Rafael Santana-Davila with the University of Washington School of Medicine explains the research advancements in immuno-oncology and the status of these treatments and clinical trials for LS-SCLC and ES-SCLC patients.

[ACT]IVATION TIP

“…patients who are diagnosed with small cell lung cancer should ask a doctor, ‘What about immunotherapy? Is that the right thing for me?’”

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Key Resources for Small Cell Lung Cancer Patients and Families

Transcript:

Lisa Hatfield:

Could you please explain research advancements in immuno-oncology and what this means for limited and extensive stage small cell lung cancer patients? And which patients have access to that?

Rafael Santana-Davila:

So, immuno-oncology is something that has completely changed the paradigm of treatment of patients with cancer, and very rough explanation, very simple is treatment that augments a patient’s own immune system so the immune system can recognize the cancer. This has changed dramatically how we, treat many cancers and many cancers, or sorry, many patients, when this is successful, can have very long survivals thanks to development of immunotherapy.

So, a few years ago, there were clinical trials that showed that the addition of PD-L1 inhibitors, which are a type of immunotherapy added to chemotherapy can both extend the duration of what we call progression-free survival, which is the amount of time before the cancer grows, as well as overall survival, which is obviously how long a patient lives.

But the addition of these medications can extend both of these numbers and is helping patients live longer. This was an extensive stage. So today there are two drugs that are approved by the FDA to add to the addition of chemotherapy. There are atezolizumab (Tecentriq), and durvalumab (Imfinzi). They are, in our eyes, equal.  One is not better than the other. And they are added to chemotherapy. Chemotherapy is continued for, in the majority of cases, for four cycles, and then patients go on to receive immunotherapy by itself. This is an extensive stage lung cancer. A limited stage lung cancer, there are current clinical trials that are asking the question of whether these medications are also worth it, do they improve things?

We do not know the answer to that question as of today. We are also very hopeful that they do, but we’re waiting for the results of those clinical trials. So which patients have access to it today is those patients that have extensive stage disease and that is the standard of care. So an activation tip for this is patients who are diagnosed with small cell lung cancer should ask a doctor, “What about immunotherapy? Is that the right thing for me?”

And in the great majority of extensive stage disease, they will be eligible for unless there are contraindications. Some very main contraindications is a history of autoimmune diseases or patients that are in immunosuppressive drugs, but that is a minority of patients.

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What Treatment Options Are Available for Small Cell Lung Cancer?

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What Treatment Options Are Available for Small Cell Lung Cancer? from Patient Empowerment Network on Vimeo.

What do extensive stage small cell lung cancer (SCLC) and limited stage SCLC patients need to know about treatments? Dr. Rafael Santana-Davila with the University of Washington School of Medicine shares a status update on where treatment options stand and discusses how he works with patients on treatment decisions.

[ACT]IVATION TIP

“…patients need to make sure that they know what the goals are. ‘What is…where am I going to…how am I going to feel in the next month? What is the likelihood that this cancer is going to shrink and this cancer is going to make me live longer?’”

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Small Cell Lung Cancer | Hope for Treatment Advancements

Transcript:

Lisa Hatfield:

So what is the latest information related to treatment options for limited stage LS and extensive stage ES small cell lung cancer? And how do you work with your patients to make treatment decisions about that?

Rafael Santana-Davila:

So this is, unfortunately, a disease where little progress has been made throughout the years because it’s a very aggressive disease. And the main improvement that has been made in the last five years is the addition of immunotherapy to chemotherapy in patients with extensive stage disease. There have now been several clinical trials that have shown that adding immunotherapy improves overall survival. That means that patients live longer.

And there is a very small, but a few patients that have, that see survival into the many years, which is something that was unthinkable before the era of immunotherapy. We do not know if the addition of immunotherapy to limited stage disease, which treatment is, in the majority of cases, chemotherapy and radiation, we do not know if that works or not, that there are clinical trials that are going on, most of them have completed accrual, so we’re just waiting for the data to mature to let us know if that is something that also works there.

We have a lot of hope that it’s the case, but right now, in September 2023, we do not know the answer for that. What I work…how I work with patients to make treatment decisions is I present them with the options of the treatment. So there are always options from being as aggressive as we can to treat it, to try to shrink the cancer, which, many times, comes at the price of side effects to just doing best supportive care, which is we know that sometimes shrinking the cancer is not what is going to make people live longer.

So it’s a conversation that we constantly have with patients where we say, “This is what we propose, this is what the consequences of treatment is going to be, and these are the alternatives.” And you have to work with them depending on their goals, depending on what they want to achieve, you make treatment decisions.

Ultimately, what I tell my patients is, “You’re the captain of the ship. I’m here just to help you navigate these rough waters, but, ultimately, you’re the one that needs to tell me where we want to go.” Okay. An activation tip is patients need to make sure that they know what the goals are. “What is…where am I going to…how am I going to feel in the next month? What is the likelihood that this cancer is going to shrink and this cancer is going to make me live longer?” Those are the questions that they need to make sure they understand.

And something that also they want to know is, what are the goals? It’s very different when you see a very young patient, their goal is to see their high school kid enter college than a 90-year-old patient that their goal is maybe to live the rest of their life with the least intervention or with the least side effects possible. So every patient has different goals. 

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Key Questions to Ask About Extensive Stage Small Cell Lung Cancer

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Key Questions to Ask About Extensive Stage Small Cell Lung Cancer from Patient Empowerment Network on Vimeo.

What should small cell lung cancer (SCLC) patients ask to help prepare themselves? Dr. Rafael Santana-Davila with the University of Washington School of Medicine shares how he explains small cell lung cancer, particularly extensive stage SCLC to patients and key questions to ask about treatment and care.

[ACT]IVATION TIP

“…you need to talk to your doctors and say, ‘Okay, what am I looking at? What are the goals of treatment? How am I going to feel in the next month? How am I going to feel in the next three months? And where am I going to be in the next six months? And what is my prognosis? And what do you expect to happen?’”

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Transcript:

Lisa Hatfield:

Dr. Santana-Davila, how do you explain extensive stage small cell lung cancer to your newly diagnosed patients? And what are key questions that patients and families should ask at the outset of their care?

Rafael Santana-Davila:

Oh, great. Thank you. Thank you for that. That is a great question. So patients who have metastatic small cell lung cancer, which is the majority of those with extensive stage, it’s a disease that is not curable, that we treat with chemotherapy and immunotherapy, that the majority of patients have a great response to treatment.

But our goal of treatment is to make patients feel better and have patients hopefully live longer. One of the key questions that families should ask at the outset of care, and this is for extensive stage cancer as well as any other cancer, is “What are the goals of treatment? What do I expect it to be? How is my life going to look a few months from now? And what can I expect?” That is, for me, very important that patients know before they start on the journey of treatment.

How do I explain what extensive stage is? What does it mean…how I explain this to patients is this is a cancer that has arose in your lung and has moved to other places. So we cannot cure it. We can treat it. We can hopefully shrink it and help you to live longer and live better. The majority of patients that present with this disease present with a lot of symptoms. They present with symptoms from the cancer. And many times it’s an emergency to try to treat them as soon as possible.

So this is a conversation that we have with them that we tell them, “It’s very likely that you will feel better, that you’ll respond to treatment.” But again, an activation tip is you need to talk to your doctors and say, “Okay, what am I looking at? What are the goals of treatment? How am I going to feel in the next month? How am I going to feel in the next three months? And where am I going to be in the next six months? And what is my prognosis? And what do you expect to happen?” 

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What Is the Difference Between Limited Stage and Extensive Stage Small Cell Lung Cancer?

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What is the Difference Between Limited Stage and Extensive Stage Small Cell Lung Cancer? from Patient Empowerment Network on Vimeo.

Limited stage and extensive stage small cell lung cancer (SCLC) are two different types, but how do they differ? Dr. Rafael Santana-Davila with the University of Washington School of Medicine explains limited stage SCLC versus extensive stage SCLC, treatment methods for each type, and the importance of communication.

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Small Cell Lung Cancer | Hope for Treatment Advancements

Transcript:

Lisa Hatfield:

Can you explain the difference between limited stage and extensive stage small cell lung cancer, please?

Rafael Santana-Davila: 

So this is actually a historical definition. Back in, I don’t know the date exactly, but somewhere in the 1980s, how we treated this was when patients…the radiation doctor could treat all the area of disease with radiation, then we call that limited. And limited stage disease means that the person, the patient can get radiation and chemotherapy with the goal of eradicating the disease. Extensive stage is when the disease cannot be treated with a single area of radiation.

In the majority of cases, there’s a very clear distinction, for example, patient has metastatic disease to the liver, that clearly is extensive, stage, but there are occasions where, limited and extensive is very hard to know and the radiation doctor would…two different radiation doctors will give you two different things.

And the important thing in this case is that this is a…all of medicine is a team sport, but treatment of cancer is more because the medical oncologists need to talk to the radiation oncologists to make sure that we’re on the same page as to what is the best treatment we can offer a patient. 

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Moving Past Small Cell Lung Cancer Stigma | A Patient Navigator Explains

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Moving Past Small Cell Lung Cancer Stigma | A Patient Navigator Explains from Patient Empowerment Network on Vimeo.

Diana is a patient navigator who assists small cell lung cancer (SCLC) patients from the stages of screening through follow-up care. Diana explains SCLC risk factors, patients commonly diagnosed with extensive stage SCLC, and barriers to care. She shares the origin of some stigma about lung cancer. “Past TV ads to stop smoking built a stigma around cigarette smoking that has created an environment of blame around lung cancer.” She discusses how patients can stay [ACT]IVATED in their care and in improving future treatments.

Disclaimer: Thank you to small cell lung cancer expert Dr. Rafael Santana-Davila, PEN’s Empowerment Leads, patients, and care partners for reviewing and collaborating on this video. This video has been edited to protect the privacy of certain individuals, and the names and identifying details have been changed.

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 Lessons From a Small Cell Lung Cancer Care Partner

Transcript:

My name is Diana, I’m a patient navigator. I help patients navigate screening, diagnosis, treatment, and follow-up care for small cell lung cancer. 

Small cell lung cancer (SCLC) makes up about 15 percent of lung cancer in the U.S. Many of these patients are diagnosed with extensive stage small cell lung cancer (ES-SCLC). Though being a current or former smoker increases the risk of SCLC, patients who were exposed to secondhand smoke, workplace carcinogens, environmental pollution, or other factors are also at-risk for SCLC.

Even though smoking is a major risk factor for SCLC, nobody deserves to get cancer. Nicotine is an addictive substance that is extremely difficult for many smokers to quit – especially for those who started at a very young age. Past TV ads to stop smoking built a stigma around cigarette smoking that has created an environment of blame around lung cancer. The stigma is many times greater for extensive stage small cell lung cancer patients. 

Patients diagnosed with SCLC can come from a variety of ethnic, racial, and social classes. However, patients from underrepresented communities of Black Indigenous People of Color (BIPOC), low socioeconomic, and LGBTQ+ groups often take on the brunt of inequitable care in the form of limited access to quality care, lack of healthcare insurance, and other barriers to care. 

Remember that you are the patient, and you have a choice in your treatment options depending on your goals for treatment and quality of life – no matter how you got the cancer. So stay encouraged as investments in SCLC research continue to fuel hope.

My [ACT]IVATION tips are:

  •   Make sure you have a full picture of available treatment options.
  •   Help educate others to raise awareness of SCLC; advocate for improved care.
  •   Inquire about small cell lung cancer clinical trials to help researchers discover new and refined treatments.

With these [ACT]IVATION tips in mind, remember, as a patient staying ACTIVATED in your cancer care is essential to becoming informed, empowered, and engaged in your care.

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