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For metastatic small cell cervix cancer, would you consider adding immunotherapy up front (per a small cell lung cancer paradigm)?

In December 2018, Horn et al reported the results of a phase 3 clinical trial in the NEJM (N Engl J Med 2018; 379:2220-2229). This trial included previously not treated patients with metastatic small cell lung cancer (PD-L1 expression not required). The patients all received carboplatin and etoposide. Double blind randomization was then used for atezolizumab vs placebo given concurrently with chemotherapy. Overall survival was improved with atezolizumab. We often talk about treating small cell cervix cancer according to the small cell lung paradigm. Following this line of thinking, do you feel it is appropriate to try to add immune therapy to this group of patients. We are unlikely to ever accrue enough small cell cervix patients to answer this question in a clinical trial. Do you feel it might be appropriate to extrapolate from lung data?
2 Answers
Mednet Member
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Radiation Oncology · University of Kentucky
Answered on

I agree that it is "not unreasonable." It is also reasonable NOT to give it. Given that these agents can have their own toxicities, which can be significant, and the potential benefit is certainly not a "home run" (and the cost is enormous) I would not add an immunotherapy agent at present.

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Mednet Member
Mednet MemberInvited Expert
Radiation Oncology · Varian Medical Systems/Allegheny health network
Answered on

It’s such a rare entity that systemic treatment is extrapolated from SCLC.

It's not unreasonable to consider systemic treatment like extensive stage small cell lung ca for metastatic small cell cervical ca.

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