Treat Early and Aggressively: Optimizing Small Cell Lung Cancer Management Across the Community Setting: With Joshua Sabari, MD

In today’s episode, we spoke with Joshua K. Sabari, MD. Dr Sabari is an assistant professor in the Department of Medicine at NYU Grossman School of Medicine, and director of High Reliability Organization Initiatives at NYU Langone Health’s Perlmutter Cancer Center New York. 

In our exclusive interview, Dr Sabari discussed the complexities of managing small cell lung cancer (SCLC) across both academic and community settings, emphasizing that nothing about this disease is straightforward. He stressed the importance of rapid diagnosis and staging, ideally within 48 to 72 hours given how quickly patients can deteriorate, and noted that in his own academic practice, approximately 30% of patients never reach second-line therapy, a figure that climbs to 50% to 60% in the community setting.

He highlighted 2 areas where community implementation frequently breaks down: first-line maintenance and second-line therapy. Regarding maintenance, Dr Sabari underscored the need to counsel patients about the combination of atezolizumab (Tecentriq) plus lurbinectedin (Zepzelca) from the outset of treatment, so the transition after 4 cycles of chemoimmunotherapy is not a surprise. In the second-line setting, he addressed the practical challenges of administering tarlatamab-dlle (Imdelltra), a CD3 x DLL3 bispecific T-cell engager, noting that the first 2 doses require inpatient monitoring given the risks of cytokine release syndrome (CRS) and immune effector cell–associated neurotoxicity syndrome (ICANS). However, he noted that these monitoring resources may not be readily available outside of academic centers.

The discussion also covered the evolving role of the multidisciplinary care team, with Dr Sabari highlighting the outsized impact of dedicated thoracic pharmacists in educating patients, monitoring for adverse effects (AEs), and intervening early, particularly with novel agents whose AE profiles are still being characterized. He shared real-world examples of coordination saves, including a radiologist who flagged early pneumonitis and a patient receiving tarlatamab who developed subtle cognitive changes that were initially missed.

Finally, Dr Sabari outlined the top educational gaps for community teams: understanding the biological heterogeneity of SCLC, recognizing when and how to use emerging agents such as tarlatamab and obrixtamig (BI 764532), and developing fluency in managing novel toxicities including CRS, ICANs, and interstitial lung disease associated with antibody-drug conjugates.