MORGANTOWN – The WVU Cancer Institute is the first provider in the state to offer a new and promising treatment for extensive-stage small cell lung cancer.
Extensive stage means the cancer has spread within the lung, to the other lung, or into the body, to summarize various medical sources.
It’s not curable, said Dr. Mohammed Almubarak, section chief of solid tumors in the Department of Medical Oncology.
The new drug is Imdelltra, made by Amgen, a biotechnology medicine developer.
“It has shown very good results and is fairly durable for many people,” Almubarak said. “It gives them more time with such an aggressive disease.”
Small-cell lung cancer is the deadliest form, he said. Imdelltra is FDA approved as a treatment when the cancer has metastasized and the patient has progressed beyond first-line treatment – chemotherapy and immunotherapy – and is offered as a second- or third-line therapy.
The FDA approved it mid-2024, he said, and the Cancer Institute participated in the clinical trials preceding approval. “So we had experience with it even before it got approved by the FDA.”
Imdelltra is a form of BiTE (bispecific T-cell engager) therapy, he said. It connects to a marker on the cancer cells and a marker on the T-lymphocytes (immune cells). The connection between the cancer and immune cells results in a response that kills the cancer cells.
It’s administered as an infusion, in the Cancer Institute’s infusion center, with “step-up dosing.”
That means it starts with a small initial dose. If the patient does OK, they come back the next week for a higher dose. And if they do OK with that, they move to the regular bi-weekly dose.
The reason for the step-up is the risk for serious complications, Almubarak said. They try to make sure the patient lives close – within an hour – or can stay close for the first two treatments. The patient needs a caretaker.
The patient requires close monitoring, should complications arise, so they can get immediate treatment for the complications.
“It’s one of those situations where there’s definitely high reward, bu there’s also high risk involved with it,” he said.
Amgen reports that in a study of 99 adult patients who had two or more prior treatments, 40% responded to Imdelltra, meaning their tumor shrank or disappeared. Two saw their tumor completely disappear, and 38 patients saw their tumor partially shrink by at least 30%.
Almubarak said the drug can be administered until it stops working, or if toxicity or side effects arise, or if the patient just wants to stop it.
It’s early in the experience with Imdrellta, he said, but it appears about half the patients get an additional year of life out of it. From there, they may switch to another approved therapy. They have people still alive who participated in the trials.
They’ve used it on three or four patients so far, and have some referrals, but they’re being careful and selective as they go. “It’s a process to get through this.”
BiTE therapy has been used for blood cancers for a few years, he said, so he and his colleagues are familiar with the type of treatment and its complications. But Imdrellta creates a whole different category of people who are eligible for this treatment.
He emphasized that there are risks, and the patient needs good support and close monitoring. The treatment isn’t offered at any WVU Medicine regional sites, only at the Cancer Institute, because of the level of monitoring needed and available services if complications arise.
“For such a tough cancer, a very aggressive cancer, this is a treatment that has shown promise.” Up to this point, they haven’t had a lot of success getting treatments for it. “It’s exciting that we have something like this now. … We have one more thing we can offer to the patients.”
