5 Things To Know About Small Cell Lung Cancer, The Lesser Known Type Of The Disease

(BPT) - Lung cancer is the second most common cancer in the United States.

According to the American Cancer Society, more than 228,000 new cases of lung cancer will be diagnosed this year.¹

The majority of people diagnosed with lung cancer have a type called non-small cell lung cancer (NSCLC), which represents 80-85% of all cases.² However, lung cancer is not just one disease, and 10-15% of people will be diagnosed with a type called small cell lung cancer (SCLC).²

Small cell lung cancer is known for being particularly aggressive and difficult to treat.

While there have been many advances in the treatment of NSCLC due to the identification of genetic drivers that can be targeted with medicine, this has not been the case with SCLC.

Because of how quickly SCLC spreads to distant parts of the body, roughly 70% of people are diagnosed when their disease is in its most advanced stage, known as extensive-stage SCLC.³

Smoking is the leading risk factor for most types of lung cancer, especially SCLC, which is almost exclusively associated with tobacco use. Other major risk factors include:⁴

• Advanced age
• Environmental exposure to radon gas
• Asbestos or other cancer-causing substances in the workplace
• Air pollution
• Arsenic in drinking water
• Radiation therapy to the lungs
• A personal or family history of lung cancer.

In some cases, people with small cell lung cancer may not show symptoms.

Because people with SCLC may not always show symptoms, it’s especially important for people with exposure to risk factors to be especially vigilant.

In later stages, small cell lung cancer symptoms include:⁵

• Fatigue
• Cough
• Shortness of breath
• Chest pain
• Loss of appetite
• Unexplained weight loss
• Coughing up phlegm or mucus
• Coughing up blood
• Swelling of the neck or face

It’s important for people to contact their doctor when they first recognize symptoms, as treatment is more likely to be effective when lung cancer is diagnosed at an earlier stage.

Stigma is one of the main barriers for people with SCLC from receiving the medical care they need.

Since the 1950s, attitudes around lung cancer have played a role in shaping perceptions of people with the disease. Due to an association with smoking, people with lung cancer often face stigma from both the general public and healthcare providers, which can impact ability to seek treatment.⁶

In 2019, the national average of those who did not receive treatment for lung cancer was 15.2%.⁷

“During my time as an oncologist, I’ve treated many people with lung cancer who have delayed seeing a doctor due to feelings of shame and guilt associated with the disease. It’s so important that we overcome this stigma that prevents people with lung cancer from receiving appropriate treatment and medical care,” commented Dr. Joan Schiller, a professor in the Department of Medicine at the Inova Schar Cancer Institute.

The first FDA-approved treatment for 1L ES-SCLC in 20 years:

For years, the standard treatment for people with SCLC has been chemotherapy, but last year the FDA approved a new type of treatment for the disease called immunotherapy, which works with a person’s immune system to identify and attack cancer cells. Immunotherapy may also affect normal cells.

Tecentriq, in combination with chemotherapy (carboplatin and etoposide), is the first FDA-approved immunotherapy medicine for the initial treatment of ES-SCLC. In the clinical trial, Tecentriq has been shown to improve outcomes for people with this form of lung cancer.⁸

Dr. Balazs Halmos, Director, Thoracic Oncology and Clinical Cancer Genomics at Montefiore Albert Einstein Cancer Center noted, “The approval of Tecentriq marked exciting progress for people with extensive-stage small cell lung cancer, offering the first approved treatment in decades that may help them live longer.”

1. American Cancer Society, Key Statistics for Lung Cancer. [Internet] https://www.cancer.org/cancer/lung-cancer/about/key-statistics.html. Accessed October 2020

2. American Cancer Society, What Is Lung Cancer? [Internet] https://www.cancer.org/cancer/lung-cancer/about/what-is.html. Accessed October 2020

3. American Cancer Society, Small Cell Lung Cancer Stages. [Internet]: https://www.cancer.org/cancer/small-cell-lung-cancer/detection-diagnosis-staging/staging.html. Accessed October 2020

4. American Cancer Society; Small Cell Lung Cancer Risk Factors. [Internet]: https://www.cancer.org/cancer/small-cell-lung-cancer/causes-risks-prevention/risk-factors.html. Accessed October 2020

5. Cancer.Net, Lung Cancer – Small Cell: Symptoms and Signs. [Internet] https://www.cancer.net/cancer-types/lung-cancer-small-cell/symptoms-and-signs. Accessed October 2020

6. Schiller J, Kolkey H, Cox M, Smith CT. Changing Attitudes Regarding Lung Cancer: Shame, Embarrassment, and Hope. Poster presentation at the 2019 World Conference on Lung Cancer on September 8.

7. American Lung Association, State of Lung Cancer 2020. [Internet]: https://www.lung.org/research/state-of-lung-cancer. Accessed November 2020.

8. Genentech. Tecentriq^® (atezolizumab) – USPI

Tecentriq U.S. Indications
Tecentriq is a prescription medicine used to treat adults with:

A type of lung cancer called small cell lung cancer (SCLC).

• Tecentriq may be used with the chemotherapy medicines carboplatin and etoposide as their first treatment when their lung cancer:
• is a type called “extensive-stage small cell lung cancer,” which means that it has spread or grown.

It is not known if Tecentriq is safe and effective in children.

Important Safety Information
What is the most important information about Tecentriq?
Tecentriq can cause the immune system to attack normal organs and tissues and can affect the way they work. These problems can sometimes become serious or life threatening and can lead to death.

Patients should call or see their healthcare provider right away if they get any symptoms of the following problems or these symptoms get worse.

Tecentriq can cause serious side effects, including:

• Lung problems (pneumonitis)–signs and symptoms of pneumonitis may include new or worsening cough, shortness of breath, and chest pain
• Liver problems (hepatitis)–signs and symptoms of hepatitis may include yellowing of the skin or the whites of the eyes, severe nausea or vomiting, pain on the right side of the stomach area (abdomen), drowsiness, dark urine (tea colored), bleeding or bruising more easily than normal, and feeling less hungry than usual
• Intestinal problems (colitis)–signs and symptoms of colitis may include diarrhea (loose stools) or more bowel movements than usual, blood or mucus in stools or dark, tarry, sticky stools, and severe stomach area (abdomen) pain or tenderness
• Hormone gland problems (especially the thyroid, adrenal glands, pancreas, and pituitary)–signs and symptoms that the hormone glands are not working properly may include headaches that will not go away or unusual headaches, extreme tiredness, weight gain or weight loss, dizziness or fainting, feeling more hungry or thirsty than usual, hair loss, changes in mood or behavior (such as decreased sex drive, irritability, or forgetfulness), feeling cold, constipation, voice gets deeper, urinating more often than usual, nausea or vomiting, and stomach area (abdomen) pain
• Problems in other organs–signs and symptoms may include severe muscle weakness, numbness or tingling in hands or feet, confusion, blurry vision, double vision, or other vision problems, changes in mood or behavior, extreme sensitivity to light, neck stiffness, eye pain or redness, skin blisters or peeling, chest pain, irregular heartbeat, shortness of breath, or swelling of the ankles
• Severe infections–signs and symptoms of infection may include fever, cough, flu-like symptoms, pain when urinating, and frequent urination or back pain
• Severe infusion reactions–signs and symptoms of infusion reactions may include chills or shaking, itching or rash, flushing, shortness of breath or wheezing, swelling of the face or lips, dizziness, fever, feeling like passing out, and back or neck pain

Getting medical treatment right away may help keep these problems from becoming more serious. A healthcare provider may treat patients with corticosteroid or hormone replacement medicines. A healthcare provider may delay or completely stop treatment with Tecentriq if patients have severe side effects.

Before receiving Tecentriq, patients should tell their healthcare provider about all of their medical conditions, including if they:

• have immune system problems (such as Crohn’s disease, ulcerative colitis, or lupus); have had an organ transplant; have lung or breathing problems; have liver problems; have a condition that affects the nervous system (such as myasthenia gravis or Guillain-Barre syndrome); or are being treated for an infection
• are pregnant or plan to become pregnant. Tecentriq can harm an unborn baby. Patients should tell their healthcare provider right away if they become pregnant or think they may be pregnant during treatment with Tecentriq. Females who are able to become pregnant:
• a healthcare provider should do a pregnancy test before they start treatment with Tecentriq
• they should use an effective method of birth control during their treatment and for at least 5 months after the last dose of Tecentriq
• are breastfeeding or plan to breastfeed. It is not known if Tecentriq passes into the breast milk. Patients should not breastfeed during treatment and for at least 5 months after the last dose of Tecentriq

Patients should tell their healthcare provider about all the medicines they take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

The most common side effects of Tecentriq when used in lung cancer with other anti-cancer medicines include:

• feeling tired or weak
• nausea
• hair loss
• constipation
• diarrhea
• decreased appetite

Tecentriq may cause fertility problems in females, which may affect the ability to have children. Patients should talk to their healthcare provider if they have concerns about fertility.

These are not all the possible side effects of Tecentriq. Patients should ask their healthcare provider or pharmacist for more information about the benefits and side effects of Tecentriq.

Report side effects to the FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch. Report side effects to Genentech at 1-888-835-2555.

Please visit http://www.Tecentriq.com for the Tecentriq full Prescribing Information for additional Important Safety Information.