ASCO 2025 | The potential of PCI for effective CNS disease management in SCLC

I think we are waiting for results from the two randomized trials comparing PCI with MRI surveillance. But I’m not sure if we get all the answers from these trials. First, we don’t have any biomarkers identifying the patients with the highest risk of developing brain metastasis. And I think we need to identify the high-risk population before we can properly assess the benefit of prophylactic cranial irradiation. I think we also need more data on long-term treatment outcomes and the risk of developing brain mets now that immunotherapy has become the new standard of care. So personally, I still believe that PCI should be offered to patients. In our trial, a higher proportion of patients received PCI than in the Adjuvant trial, And similarly, we also see that the patients receiving PCI had a longer survival. So I’m a little bit skeptical about omitting PCI routinely. After all, a lot of the skepticism regarding PCI is based on data from the Japanese trial on PCI versus MRI surveillance in extensive-stage small cell lung cancer, which is probably a different setting than patients who have received chemotherapy in limited-stage disease and now when immunotherapy comes in addition.

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