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The Alliance phase II, multi-institutional trial evaluated SRS/SRT in small cell lung cancer (SCLC) patients with 1-10 brain metastases, showing a 1-year neurologic death rate of 11.0% vs 17.5% with historical whole brain radiation therapy (WBRT) controls, and a median OS of 10.2 months. Notably, only 22% required salvage WBRT, and 78% avoided WBRT entirely, with high rates of local control and manageable toxicity. The incidence of new brain mets was high (1-year: 59%), but most were managed with salvage SRS/SRT rather than WBRT. In short, for SCLC patients with limited brain mets, SRS/SRT with close MRI surveillance looks like a real alternative to upfront WBRT, potentially preserving neurocognition without compromising intracranial control.

Impressive improvement in overall survival when comparing 55 vs 33 months and progression-free survival (almost double) due to tolerable toxicity. Now in NCCN guidelines…

Improved outcome in patients with brain metastases, but only uses a small number. It is still promising.

Very interesting study using tarlatamab, a bispecific T-cell engager that directs T-cells to malignant cells expressing delta-like ligand 3 (DLL3). This was a dose escalation phase II, ORR was 40% and the longevity of response in responders was impressive for this disease. Further studies are sure to come.