Tejas Patil, MD, of the University of Colorado Cancer Center, reviews key small cell lung cancer updates from WCLC 2026, including SWOG S1827 MAVERICK and the evolving role of prophylactic cranial irradiation. He also highlights emerging B7-H3 ADCs and DLL3-targeted CAR T-cell therapy as promising strategies for relapsed or refractory disease.
Transcript:
Dr. Patil: Hello everyone, my name is Tejas Patil. I’m a thoracic oncologist at the University of Colorado Cancer Center.
What were the most important studies or themes from WCLC 2026 that you believe will have the greatest impact on the management of lung cancer?
Dr. Patil: Yeah, there was a lot presented at the World Lung Cancer Conference in 2026 this year. I think at a high level, the most impactful data to me came in the small cell lung cancer space. I think here we saw a couple of very important presentations that will change practice, and if not change practice, at least set the stage for therapies that I think will be very disruptive.
Starting immediately as my top pick for most practice-changing presentation, it was the SWOG S1827 MAVERICK study. This was a really important trial because I think for decades in small cell lung cancer, there had been this practice pattern of offering prophylactic cranial irradiation.
And a lot of this was based off of clinical trials that were done in an era that preceded both the ability to deliver stereotactic radiosurgery, but also MRI surveillance. The Takahashi study did show that in the modern era with MRI surveillance and SRS, there might be a question as to whether prophylactic cranial irradiation really has a role.
And I think what MAVERICK settled for me in kind of a very definitive way was that if you look at extensive-stage small cell and limited-stage small cell, there really is no difference in the cognitive-free, progression-free survival. And this is important because when we think about the net harm of PCI, one of the things, even with novel strategies such as hippocampal sparing and use of memantine, cognitive burden is a big issue.
And I think one of the things this study highlights is that in the modern era, especially now that we’re integrating immunotherapies and potentially DLL3 T-cell bispecific engagers, it really brings to question what’s the role of prophylactic cranial irradiation. In my view, that era is over. I think SWOG, MAVERICK, effectively adjudicated on that point.
The other studies in small cell that I think were really interesting were the two presentations looking at the B7-H3 ADCs. And what I think was novel about these strategies is if you look at cytotoxic treatments in relapse refractory small cell, there’s never been a single study that has shown superiority to another cytotoxic.
The drug that’s often used, and historically has been the gold standard, was topotecan, but it should be remembered that the original study that looked at topotecan compared it to best supportive care, and then a subsequent study that looked at topotecan was compared to CAV and was shown to be non-inferior to CAV, but not better.
And I think what we’re seeing here with the B7-H3s in particular is a potential window for newer drugs that may displace topotecan and actually start to have more of a central role in the management of small cell lung cancer. There was some very preliminary data on a novel construct that again is very intriguing, and just shows that there’s a lot of dynamic developments in the small cell lung cancer space.
In particular, I was very interested in LB2102. This was a DLL-targeted CAR T-cell, construct. Again, this was Phase I data, very small numbers. But what was fascinating about it was that there was a finding that showed that lower pre-infusion lymphocyte count did associate with higher levels of IL-15 on day one, and then subsequently better clinical responses at, you know, albeit these are sort of small numbers, and we’ll have to see how this study matures.
