SCLC highlights from WCLC 2026
MAVERICK revisits the prophylactic cranial irradiation debate in SCLC
MRI surveillance preserved cognition without compromising survival in SCLC
Brain magnetic resonance imaging (MRI) alone improved cognitive outcomes without compromising survival compared with MRI plus prophylactic cranial irradiation (PCI) in patients with small-cell lung cancer (SCLC), according to findings from the phase 3 SWOG S1827/MAVERICK trial presented at the 2026 World Conference on Lung Cancer (WCLC 2026).
Chad G. Rusthoven (University of Colorado, Aurora, USA) reported that MRI surveillance significantly improved cognitive failure-free survival (CFFS) compared with MRI plus PCI (HR, 0.60; 90% CI, 0.46–0.78; p=0.0005).
The benefit of MRI surveillance was observed across disease subgroups and was not influenced by disease stage or receipt of immunotherapy. Among patients with limited-stage (LS) disease, the HR for CFFS was 0.59, while in extensive-stage (ES) disease it was 0.65.
MAVERICK included 303 patients with LS-SCLC or ES-SCLC who had completed initial therapy and had no evidence of brain metastases on MRI. Patients were randomized 1:1 to MRI alone (n=151) or MRI plus PCI (25 Gy in 10 fractions; n=152). Brain MRIs were performed every 3 months during the first year and every 6 months during the second year. Most participants (68%) had LS-SCLC, and 41% had received immunotherapy as part of upfront treatment.
Despite a higher incidence of brain metastases with MRI alone, overall outcomes remained comparable between treatment strategies. At 12 months, brain metastases occurred in 30% of patients receiving MRI alone compared with 15% of those receiving MRI plus PCI. However, preliminary overall survival analyses conducted after 128 deaths showed no significant difference between the groups (HR, 0.90; 90% CI, 0.67–1.20), and progression-free survival was also similar (93 vs 91 events; HR 0.96; 90% CI, 0.75–1.23).
MRI alone was associated with substantially lower toxicity. Grade 3–5 treatment-related adverse events occurred in 0.8% of patients in the MRI-alone arm compared with 7.9% in the MRI plus PCI arm, which included one treatment-related grade 5 encephalopathy event.
Discussant Hideyuki Harada said the results strengthen the case for MRI surveillance in the modern era but cautioned that access to MRI remains a practical consideration. He also noted that the role of PCI in limited-stage SCLC may depend on mature overall survival data from MAVERICK and the ongoing PRIMALUNG trial.
B7-H3s in relapsed SCLC: Key findings from TAISHAN-302 and ARTEMIS-008
B7-H3 ADCs significantly improved survival versus topotecan in relapsed SCLC
Two phase 3 studies presented at WCLC 2026 demonstrated substantial survival benefits for B7-H3–targeted antibody–drug conjugates (ADCs) compared with topotecan in patients with relapsed small-cell lung cancer (SCLC), highlighting the growing potential of ADCs in the second-line setting.
Li Zhang (Sun Yat-sen University Cancer Center, Guangzhou, China) presented results from the phase 3 TAISHAN-302 trial evaluating tambotatug pelitecan (Tam-Peli). Among 451 patients randomized 1:1 to Tam-Peli (n=225) or topotecan (n=226), median overall survival (OS) was 13.3 months with Tam-Peli versus 9.4 months with topotecan (HR, 0.46; 95% CI, 0.35–0.62; p<0.0001). Median progression-free survival (PFS) was 7.4 versus 2.8 months, respectively, while objective response rates (ORR) were 59.1% and 9.7%. Notably, intracranial activity was also observed, with median intracranial PFS of 6.1 versus 4.2 months and intracranial ORR of 32.4% versus 2.9%.
Results from the ARTEMIS-008 trial, presented by Jie Wang (National Cancer Center, Beijing, China), showed similarly impressive efficacy for risvutatug rezetecan (Ris-Rez). In 461 patients with relapsed SCLC, median OS was 18.5 months with Ris-Rez (n=230) compared with 10.3 months with topotecan (n=231; HR, 0.46; 95% CI, 0.35–0.62; p<0.0001). Improvements were also seen in blinded-independent central review-assessed PFS (7.2 vs 3.0 months, respectively), ORR (58.3% vs 12.6%), and disease control rates (90.4% vs 60.2%). Benefits were consistent across predefined subgroups, including patients with brain metastases and those with a chemotherapy-free interval of <90 days.
Both ADCs demonstrated lower rates of grade ≥3 treatment-related adverse events than topotecan (46.4% vs 74.7% in TAISHAN-302, 60.9% vs 78.2% in ARTEMIS-008). Interstitial lung disease (ILD)/pneumonitis rates were relatively low with Tam-Peli (4.9%) versus topotecan (1.4%) but higher with Ris-Rez (11.7%) versus topotecan (1.9%), although no grade 4 or 5 ILD events were reported in either study.
Discussant Anne Chiang noted that both studies support B7-H3–targeted ADCs as emerging treatment options in relapsed SCLC. However, she cautioned that differences in study populations and both trials being conducted exclusively in China may limit cross-trial comparisons and global generalizability, while highlighting the need to better understand treatment sequencing as additional ADCs enter the field.
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