Ticiana Leal, MD

Dr. Leal addresses diagnostic challenges with newer therapies, particularly tarlatamab's potential neurologic side effects including immune effector cell-associated neurotoxicity syndrome (ICANS), which can manifest as weakness and create diagnostic overlap concerns with cancer-associated LEMS symptoms.

Dr. Leal addresses the complex interaction between cancer-associated LEMS as an autoimmune condition and standard SCLC therapies, particularly immunotherapy agents like checkpoint inhibitors and newer treatments like tarlatamab T-cell engagers.

Dr. Leal introduces amifampridine, an FDA-approved oral potassium channel blocker that increases acetylcholine release at neuromuscular junctions for treating LEMS, including cancer-associated cases.

Dr. Leal discusses the updated NCCN guidelines recommending VGCC antibody testing for patients with suspected neurologic paraneoplastic syndromes like cancer-associated LEMS, asking about the impact of these guideline changes on awareness and testing rates in community and academic settings. Dr. Iams acknowledges the guidelines help somewhat but emphasizes that broader awareness of the diagnosis and specific available treatments remain more significant factors in improving recognition.

Dr. Ticiana Leal from Emory University's Winship Cancer Institute and Dr. Wade Iams from Tennessee Oncology introduce their discussion on Lambert-Eaton myasthenic syndrome (LEMS) in patients with small-cell lung cancer (SCLC). This paraneoplastic syndrome affects approximately 3% of patients with SCLC but remains undiagnosed in up to 90% of cases, representing a significant clinical challenge where symptoms often overlap with expected disease progression or treatment-related adverse effects in busy oncology settings.

Ticiana Leal, MD, discusses how emerging targeted therapies for extensive-stage small cell lung cancer (ES-SCLC) are showing promising objective clinical outcomes that may surpass those of second-line treatments such as topotecan and CAV regimens, particularly highlighting the need to evaluate specific compounds based on platinum-sensitive vs platinum-resistant disease profiles and the potential role of TIGIT inhibitors in future treatment lines.

Ticiana Leal, MD, discusses how lurbinectedin, a synthetic alkaloid derived from marine sources, exerts its antitumor effects by binding to DNA and disrupting repair mechanisms, highlighting promising efficacy results in the Phase 2 PMO1183 trial, where it achieved a 45% objective response rate (ORR) and an 11.2-month median overall survival in patients with relapsed small cell lung cancer (SCLC).

Ticiana Leal, MD, discusses how ifinatamab deruxtecan, a B7-H3 antibody-drug conjugate, targets the overexpressed B7-H3 in extensive-stage small cell lung cancer (ES-SCLC) to potentially enhance immune response and improve clinical outcomes, as highlighted by efficacy results from the Phase 1/ 2 IDeate-Lung02 study, which reported a 52.4% objective response rate and a 12.2-month overall survival (OS).

Ticiana Leal, MD, discusses how tarlatamab, a bispecific T-cell engager (BiTE), leverages the aberrant expression of delta-like ligand 3 on small cell lung cancer (SCLC) cells to direct T-cell-mediated tumor lysis, its promising efficacy shown in the phase 2 DeLLphi-301 study, and the potential clinical benefits of combining it with durvalumab for maintenance therapy after platinum-based chemotherapy.

Ticiana Leal, MD, discusses how in cases of extensive stage small cell lung cancer (ES-SCLC) that progress within 6 months of platinum-based chemotherapy, treatment options such as tarlatamab, lurbinectedin, topotecan, and irinotecan should be considered, alongside the potential to extend chemoimmunotherapy cycles. She also addresses the impact of National Comprehensive Cancer Network (NCCN) guidelines and the consideration of prophylactic cranial irradiation (PCI) despite negative brain imaging results.

Ticiana Leal, MD, discusses how recently approved targeted therapies for small cell lung cancer (SCLC) significantly enhance survival outcomes and reshape treatment strategies for both limited and extensive stages of the disease.

Dr Ticiana Leal, MD, highlights the approvals of new regiments in small cell lung cancer. However, she discusses the struggles physicians currently face, such as identifying predictive biomarkers used to select patients who may respond well to new treatment regiments.

Dr Ticiana Leal, MD, describes the choice to prescribe lurbinectedin in the second-line setting for the patient as well as her personal experience with the drug.

Dr Ticiana Leal, MD, discusses the role of topotecan and lurbinectedin as novel agents in second-line therapy for small cell lung cancer.

Dr Ticiana Leal, MD, lists the treatment options associated with first-line therapy and its relation to platinum sensitivity.

Dr Ticiana Leal, MD, comments on the treatment given, the effectiveness of treatment, and the future prognosis of this patient with small cell lung cancer.

Dr Ticiana Leal, MD, outlines the specific demographic and diagnosis of a patient with small cell lung cancer.

Ticiana Leal, MD, presents a case of a 61-year-old man with small cell lung cancer.