Stephen Liu, MD, chief of hematology and oncology at Georgetown University, reviews important small cell lung cancer findings from WCLC 2026. He discusses how the phase 3 MAVERICK trial challenges the routine use of prophylactic cranial irradiation in the era of MRI surveillance and highlights promising phase 3 data for B7-H3–directed antibody-drug conjugates that improved survival compared with topotecan.
Transcript:
Dr. Liu: Hi, my name is Dr. Stephen Liu. I’m the chief of hematology and oncology at Georgetown University.
WCLC includes several studies that could influence thoracic oncology. Which result do you think is most likely to change clinical practice, and why?
Dr. Liu: I think one of the studies from WCLC 2026 that immediately changes practice is the MAVERICK study. This is a SWOG cooperative group trial looking at prophylactic cranial radiation in patients with small cell lung cancer. And PCI is sort of an, I would say, somewhat antiquated tool. It certainly is effective at reducing the risk of brain metastases. But the real question is, does this change survival? And based on older studies and meta-analyses that were including studies done before I was born, those studies showed that giving PCI in patients with small cell lung cancer both reduced the risk of brain metastases and improved survival.
But it’s been called into question in the MRI era for a couple reasons. When we’re doing MRIs, we can identify occult brain metastases a little better and sort of distinguish between people that would be candidates for prophylactic strategies and those that actually need more therapeutic radiation. And so it’s patient identification, but also with MRI surveillance, can we identify brain metastases earlier with regular screening studies so that we can intervene before it has an impact on outcomes? And now with salvage radiation technologies like stereotactic radiation, you know, is PCI still playing the same role?
And the Japanese phase 3 study in extensive-stage small cell cancer really showed no difference in survival, but we had still an open question in limited stage. The MAVERICK study, which included both limited and extensive stage, really showed no difference in survival. That wasn’t the primary endpoint. The primary endpoint was really cognitive failure-free survival, which also favored MRI surveillance too.
And my takeaway from that is really that PCI, you know, is something that I will not really be offering to patients at this point. I think there are still some open questions that can be answered. There’s a European study. The survival still needs to mature. I think these are all appropriate caveats, and it may not be completely powered in terms of looking at limited stage versus extensive stage. I think we’ll watch those data very closely.
Right now, my opinion as a clinician is that the burden of proof is on showing me that this strategy has some benefit to patients, and so it’s sort of, I think, flipped our perspective. While there’s still a possibility, I think you’ll need to prove it before we start regularly recommending it. So to me, that’s something that we walk away with immediately.
There are a lot of important studies that have come out, and I think some of the phase 3 data are very exciting. Not all those drugs will be available in the US. I’m thinking specifically of the B7-H3 antibody-drug conjugates in small cell lung cancer that really blew topotecan out of the water. Consistent survival benefit, looking at hazard ratios south of 0.5 for two phase 3 trials, and I think well-designed studies, two studies that are reinforcing each other. I’m very excited about those drugs, but they won’t change practice just yet, apart from sending people to those trials in the US, because the drugs simply aren’t available. But certainly those will be changing or affirming in China.
