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Small cell lung cancer (SCLC) is a highly aggressive disease with a poor prognosis. The ongoing focus has been on finding effective second-line treatment options after initial platinum-based chemotherapy has failed, but most of the treatments currently available have significant side effects and limited efficacy.

The recent 2-part phase II/III RESILIENT trial provides new insights into the efficacy and safety of liposomal irinotecan compared with topotecan in patients with relapsed SCLC and progression on or after first-line platinum-based chemotherapy.

This randomized study involved 461 patients and aimed to evaluate overall survival (OS) as the primary endpoint, with secondary endpoints including progression-free survival (PFS) and objective response rate (ORR). The median OS and PFS were similar for both treatments. However, liposomal irinotecan showed a higher ORR (44.1%) compared with 21.6% for topotecan.

Crucially, the study highlighted a more favorable safety profile for liposomal irinotecan, with fewer patients experiencing severe treatment-emergent adverse events (TEAEs) and TEAE-related discontinuation than those receiving topotecan. The higher ORR and better safety profile of liposomal irinotecan suggest it can provide significant clinical benefits by reducing tumor burden and improving patient well-being, despite not extending overall survival compared with topotecan.

Tailoring therapy to individual patient profiles, considering both efficacy and quality of life, could lead to better overall outcomes and patient satisfaction. The RESILIENT trial is one of the many trials trying to fill the ongoing need for more nuanced, effective, and patient-centered approaches in SCLC treatment. The higher ORR and improved tolerability of liposomal irinotecan support future research into its use in combination therapy.

Arun Kumar, MD, is a hematology and oncology fellow at MedStar Georgetown University Hospital in Washington, D.C.; Munther Hammad, MD, is an internal medicine resident at MedStar Washington Hospital Center in Washington, D.C.; and Noor Saneh Mobarek, is a bioengineering student at the University of Maryland in College Park.

Read the study here and a Q&A related to it here.