In today’s episode, we spoke with Alissa Cooper, MD. Dr Cooper is a physician at Dana-Farber Cancer Institute and an instructor in medicine at Harvard Medical School in Boston, Massachusetts. In our exclusive interview, Dr Cooper discussed recent advances that have reshaped the treatment paradigm for small cell lung cancer (SCLC), particularly in the relapsed setting. She highlighted the FDA approval of tarlatamab-dlle (Imdelltra), a DLL3-targeting T-cell engager, as one of the most impactful developments in recent years. Despite this progress, Cooper emphasized that the frontline standard of care has remained largely unchanged, continuing to rely on platinum-based chemotherapy in combination with immunotherapy. She noted that, although ongoing clinical trials are exploring biomarker-driven strategies and novel combinations, a more personalized first-line approach has yet to be established. The conversation also explored real-world treatment sequencing and decision-making at the point of relapse. Cooper explained that, whenever feasible, oncologists aim to enroll patients in clinical trials or initiate treatment with tarlatamab. However, logistical barriers, including trial screening requirements and the need for monitored administration of T-cell engagers, can delay care. In cases of rapidly progressing disease, oncologists may instead turn to cytotoxic therapies such as lurbinectedin (Zepzelca) or use localized approaches like radiation to achieve faster disease control. The importance of multidisciplinary coordination was another key theme. Cooper underscored that SCLC management requires rapid collaboration among medical oncologists, radiation oncologists, pulmonologists, pathologists, and supportive care teams. Early involvement of palliative care is also critical, given the aggressive nature of the disease and high symptom burden. Additionally, she highlighted the essential role of oncology pharmacists, nursing teams, and structured patient education. Clear toxicity management protocols, dose-modification guidelines, and comprehensive patient education visits help ensure safe treatment delivery and empower patients to manage adverse effects. Looking ahead, Cooper described an “embarrassment of riches” in emerging therapies and targets under investigation. Beyond DLL3, novel approaches targeting markers such as SEZ6 and B7-H3, as well as next-generation antibody-drug conjugates and trispecific T-cell engagers, are showing early promise. However, key questions remain regarding biomarker selection, treatment sequencing, and real-world effectiveness, particularly for patients who would not meet clinical trial eligibility criteria. Finally, she emphasized that improving coordination between community and academic centers is essential to ensuring timely access to innovative therapies and clinical trials. Strengthening communication pathways and referral processes may help bridge gaps in care and improve outcomes for patients with this aggressive disease.
