Millie Das, MD, of Stanford University and the VA Palo Alto Health Care System, reviews key small cell lung cancer findings from the IASLC 2026 World Conference on Lung Cancer. She discusses how results from the phase 3 MAVERICK trial support brain MRI surveillance as an alternative to prophylactic cranial irradiation, promising survival data for B7-H3–directed antibody-drug conjugates in relapsed disease, and the potential movement of tarlatamab into the maintenance setting. Dr. Das also highlights the need for more accessible tarlatamab dosing and administration strategies so patients across different health care settings can benefit from treatment.
Transcript:
Dr. Das: I’m Millie Das. I’m a thoracic medical oncologist at Stanford University and at the VA in Palo Alto.
Which SCLC study presented at the conference do you think has the greatest potential to alter clinical practice?
Dr. Das: I think today was an exciting day at the World Conference on Lung Cancer, here in Seoul. In the plenary session, we heard a number of abstracts related to small cell lung cancer. As a small cell lung cancer researcher, I was particularly excited to see so many abstracts and data presented in this really exciting space.
I think the one that really stood out to me that’s immediately practice changing is the MAVERICK study. That was a study that looked at PCI, or prophylactic cranial radiation, versus brain MRI surveillance alone in patients with both limited stage and extensive stage disease. And what we saw was that there was no difference in progression-free or overall survival between the two treatment arms for PCI versus no PCI, with brain MRI surveillance being performed in both treatment arms.
We also saw that the time to cognitive failure was superior in patients who did not receive PCI. So I would say many of us in clinical practice were sort of leaning away from PCI, given the cognitive toxicities associated with PCI, and I think this study really just confirms this. Where there was perhaps more data was in the limited stage setting. But with this study including both limited and extensive stage patients, I think I would feel very comfortable omitting PCI in all of my small cell lung cancer patients and instead continuing on with close brain MRI surveillance in these patients and considering stereotactic radiosurgery if and when brain metastases develop, provided that they remain within a limited number.
What should clinicians take from MAVERICK about brain MRI surveillance and prophylactic cranial irradiation?
Dr. Das: I think a lot of the data that supported the use of prophylactic cranial irradiation was really done in the era before we were doing brain MRI surveillance. And so this study was important because, of course, now we have brain MRI surveillance that we’re able to do. Some of us have seen the really terrible side effects, the cognitive side effects of PCI, so I think again this study is more practice affirming for most of us, which is to say that if we were not really having those PCI discussions or maybe veering our patients away from PCI, we should continue to feel very comfortable doing that with the data that was shown from the MAVERICK study today.
How do the TAISHAN-302 and ARTEMIS-008 results help define the role of B7-H3 ADCs in relapsed SCLC?
Dr. Das: Yeah, I think this is a really exciting space right now in small cell lung cancer where we have a number of different antibody-drug conjugates that are showing really promising efficacy, including several ADCs that target B7-H3, which is a tumor target antigen that’s highly expressed in small cell lung cancer.
The data that we heard today in the plenary is from two different B7-H3-targeting ADCs. And again, we’re seeing very promising efficacy here in randomized phase 3 trials that were conducted in China, where the ADC was compared to topotecan, which is the historical standard. Both the Tam-Peli and the Ris-Rez antibody-drug conjugates showed significant improvement in both progression-free and overall survival compared to topotecan, also with a significant reduction in toxicity.
Very encouraging data. We do want to see how this data plays out in a more global setting. Again, these were China-only studies, which will need to be replicated in a global population.
What is most important to understand about newer tarlatamab dosing and toxicity management?
Dr. Das: I think we saw a press release recently from the DeLLphi-305 study showing that tarlatamab maintenance therapy is showing significant improvement in outcomes. And, of course, we’re going to hear the actual data presented at an upcoming conference. I would say pending that, we need to continue to think about how our small cell lung cancer patients are going to get access to tarlatamab.
Now, with it potentially being moved into the maintenance setting, we know that right now it is recommended and it’s part of the package insert that patients get admitted to receive their first two doses of tarlatamab. And this is not always feasible in all health care settings. Many of these patients with small cell lung cancer are living in more rural settings where they are not having easy access to tarlatamab.
There is some data that’s going to be presented at this year’s World Conference on Lung Cancer on sub-Q dosing of tarlatamab and also with spacing out the dosing of tarlatamab, which is going to potentially allow this drug to be more easily administered for our patients and hopefully also improve access.
So I think these are really important questions. We should get some preliminary answers from the data that’s going to be presented soon. And as I think about tarlatamab and again thinking about moving this into the maintenance setting, I want to make sure that all of our patients with small cell are going to have access to this drug.
