The 'Small Cell Lung Cancer – Global Clinical Landscape 2024' report of clinical trial services company Novotech offers hope to those suffering from the aggressive cancer type, detailing innovations in therapeutic strategies and a raft of new treatments in development.
This report details 26 early-stage and 88 clinical trial-stage treatments being developed for small cell lung cancer (SCLC), with phase III trials (17 drugs) focusing predominately on immunotherapies and antibody-drug conjugates.
There has also been a breakthrough in the sector’s understanding of SCLCs, with four subtypes identified - SCLC-A, SCLC-N, SCLC-P and SCLC-I.
The inflammatory subtype SLCL-I – accounting for 15% of cases – has shown improved responses to immunotherapy.
Immune system at centre of innovation
Many of the new treatment strategies for SLCL rely on emerging molecular and genetic profiling technologies.
A greater understanding of the cancer’s subtypes has also enabled tailored approaches to individual disease, including the use of immune checkpoint inhibitors (ICIs) and Aurora kinase inhibitors to inhibit cancer cell growth and replication.
These tailored therapies focus on specific pathways involved in SCLC proliferation and repair, minimising off-target effects and improving tolerability.
They’ve also demonstrated improved survival in extensive-stage SCLC compared to chemo and radiotherapy, using ICIs to harness the body’s immune system to attack cancer cells more effectively.
For more resistant cancers, researchers are also working with antibody-drug conjugates (ADCs) and bispecific antibodies, including:
- Tarlatamab (DLL3 targeting) - Combines high specificity for tumour markers with robust efficacy, showing a 40% objective response rate in pre-treated SCLC patients.
- Bispecific antibodies (eg, QL1706) - Enhance tumour recognition by combining chemotherapy with immune checkpoint modulation.
High unmet need
Despite the progress made, Novotech’s report highlights the need for continued innovation – SLCL is a highly aggressive cancer with poor prognosis due to early metastasis, high tumour heterogeneity and treatment resistance.
It also points out that the Asia-Pacific region has a high incidence of disease but low trial density, representing both an unmet need and a research opportunity.
The report concludes that while the prognosis for SCLC remains poor, the integration of personalised medicine, novel therapies and immunotherapy offers hope for improved patient outcomes.
Addressing challenges such as treatment resistance, late-stage failures and trial inefficiencies will be essential for the field to realise its full potential.
Of the 250,000 people diagnosed with SCLC each year, about 200,000 will succumb to it.
ASX companies developing immunotherapies
There are a wide variety of biotech companies on the ASX, with many of them targeting cancer via immunotherapies and drug conjugate strategies.
Arovella Therapeutics Ltd (ASX:ALA) is developing an Invariant natural killer T (iNKT) cell technology platform, leveraging the body’s own immune cells and engineering them with a Chimeric antigen receptor (CAR) to boost the cell’s cancer-killing abilities.
Read: Arovella Therapeutics moves toward IND for ALA-101 lymphoma and leukaemia trials with positive FDA feedback
Imugene Ltd (ASX:IMU, OTC:IUGNF) is also leveraging CAR T cells, this time using off-the-shelf (allogeneic) cell therapy CAR T drug Azer-Cel (azercabtagene zapreleucel) which targets CD19 to attack blood cancer.
The company is also developing an oncolytic virus (a virus engineered to kill cancer), the onCARlytics (CF33-CD19) treatment targeting solid tumours.
Read: Imugene Phase 1 onCARlytics trial doses first patient in intratumoural combination arm
Prescient Therapeutics Ltd (ASX:PTX, OTC:PSTTF) has three separate technology arms:
- PTX-100 targeted therapy, which blocks an important cancer growth enzyme
- CellPryme cell therapy platform, designed to enhance CAR-T efficacy
- OmniCAR cell therapy, a modular, universal CAR platform based on technology licensed from UPenn and Oxford University.
Read: Prescient Therapeutics refines Phase 2 PTX-100 trial design for greater success
Patrys Ltd (ASX:PAB) is developing the Deoxymab pipeline, using the PAT-DX3 full-sized antibody to target brain cancers, and in treating cancers and/or metastases that are associated with NETosis, or in combination with DNA damaging agents such as radiation and many chemotherapy drugs.
The PAT-DX1 antibody fragment has been manufactured at a large scale, seeking strategic partnerships for co-development and licensing.
Read more: Patrys focused on manufacturing run of PAT-DX1 in June quarter
Race Oncology Ltd (ASX:RAC, OTC:RAONF) is taking a different tact, leveraging bisantrene in combination with chemotherapy anthracycline as a cardio-protective agent.
Read: Race Oncology RC110 bisantrene treatment meets efficacy goals in Phase 2 acute myeloid leukaemia trial