In today’s episode, we spoke with Ticiana Leal, MD, about variability in community practice and evolving treatment strategies for patients with small cell lung cancer (SCLC). Dr Leal is a professor and director of the Thoracic Medical Oncology Program in the Department of Hematology and Medical Oncology at Emory University School of Medicine, as well as the medical director of the Clinical Trials Office at Winship Cancer Institute in Atlanta, Georgia.

In our exclusive interview, Dr Leal began by discussing how SCLC management can differ widely across community settings according to how patients present. Leal emphasized the importance of quickly confirming a patient’s diagnosis and initiating treatment to avoid missing the critical window where chemotherapy could provide meaningful clinical benefit. However, Leal noted that the field still lacks predictive biomarkers to guide treatment selection. Accordingly, current strategies, including chemoimmunotherapy, maintenance approaches, and second-line options like tarlatamab-dlle (Imdelltra) and lurbinectedin (Zepzelca) are largely chosen based on clinical factors such as disease burden, comorbidities, and patient preferences.

The conversation then shifted to the challenge of treating patients who may not meet traditional clinical trial eligibility criteria due to poor performance status, comorbidities, or social vulnerabilities. Leal stated that a multidisciplinary approach, including collaboration with supportive care teams, is essential to optimize outcomes for these patients. She noted that potential solutions to restrictive trial eligibility criteria may include decentralizing trials, improving collaboration between academic and community centers, and providing additional patient support such as transportation and care navigation services.

Looking ahead, Leal emphasized the need for community practices to prepare for emerging therapies, including antibody-drug conjugates and novel immunotherapy approaches. Successfully integrating these treatments into everyday practice will require education, infrastructure development, and multidisciplinary collaboration, Leal imparted.