Small Cell Lung Cancer: Pharmacologic Management

Small cell lung cancer (SCLC) accounts for approximately 14% of lung and bronchus cancers,¹ with approximately 30,000 to 35,000 new cases diagnosed in the United States each year.² In 2023, the National Cancer Institute (NCI) estimates that there will be 238,340 new cases of lung and bronchus cancer, which includes both SCLC and non-small cell lung cancer (NSCLC), and approximately 127,070 deaths.^3,4 In recent years, the incidence of SCLC has been decreasing; however, the COVID-19 pandemic has likely affected recent estimates as many patients may not have been properly diagnosed and treated during this time.¹ 

The largest risk factor for developing SCLC is a history of cigarette smoking or exposure to secondhand smoke.¹ Occupational exposure to other chemicals and substances such as asbestos, chromium, nickel, arsenic, and beryllium by those working in construction, refineries, and metallurgy is also associated with an increased risk of SCLC. Patients who have been previously treated with radiation therapy to the chest or breast or who have been exposed to radon for an extended period of time are also at increased risk of developing SCLC.⁴ 

Small Cell Lung Cancer Staging

Although the American Joint Committee on Cancer (AJCC) has developed a cancer staging and grading system to assist in treating SCLC, physicians often opt to use the older Veterans Administration (VA) guidance for SCLC that uses 2 stages — limited stage and extensive stage.⁵ The National Comprehensive Cancer Network (NCCN) recognizes this and has applied a combined approach when outlining its treatment guidelines for SCLC.¹ 

SCLC is an aggressive disease characterized by the early occurrence of metastases, which is likely due to the accelerated doubling time and high growth fraction of SCLC cells.¹ According to the NCCN and NCI, approximately 30% of patients present with limited-stage disease at the time of diagnosis.^1,4 In those cases, the cancer is limited to the mediastinum, supraclavicular lymph nodes, and the side of the chest where it originated. The NCCN categorizes limited-stage disease as stages I to III. The remaining 70% of patients have extensive-stage disease that has spread outside of the supraclavicular area at the time of diagnosis. The NCCN categorizes extensive-stage disease as stage IV. 

Small Cell Lung Cancer Treatment Recommendations

Few pharmacologic treatment options currently exist for SCLC, and systemic therapy is currently the mainstay of SCLC treatment. Only 5% of patients with SCLC qualify for surgery as most patients present with spread of disease to lymph nodes and other organs at diagnosis.⁵ Approximately 25% of patients who present with limited-stage NCLC and undergo prompt treatment can be cured of the disease.²  Patients with extensive-stage SCLC may experience an initial response to chemotherapy and radiation therapy. However, the disease often recurs in a resistant and more aggressive manner. Considering the paucity of treatments available, the NCCN recognizes that clinical trials may offer the best option to patients, and their participation should be strongly encouraged.¹ 

Primary and Adjuvant Treatment in Limited-Stage SCLC

All patients who have undergone surgery or stereotactic ablative radiotherapy (SABR) for SCLC should receive adjuvant chemotherapy. Those who were ineligible for surgery should receive a combination of chemotherapy and thoracic radiation therapy. The 2 most commonly used treatment combinations are etoposide + cisplatin and etoposide + carboplatin.

Carboplatin and cisplatin both belong to the class of chemotherapy drugs known as alkylating agents. They interact with electron-rich molecules such as amino nitrogens and thiol sulfurs to covalently link to nucleic acids and proteins in cells. This linking disrupts mitosis and basal cellular functions, forcing cells to undergo programmed cell death (apoptosis).⁶ 

Clinical trials have shown that carboplatin and cisplatin are equally effective for SCLC and can be interchangeable. One meta-analysis of 4 studies comparing carboplatin-based and cisplatin-based regimens found that there was no significant difference in progression-free survival, overall survival, or response.⁷ Physicians may choose to substitute carboplatin for cisplatin to reduce the risk of unwanted side effects, including nephropathy, emesis, and neuropathy. 

Recommended doses and scheduling for the preferred primary and adjuvant treatment of SCLC are as follows:

• Cisplatin 75 mg/m² on day 1 and etoposide 100 mg/m² on days 1, 2, and 3
• Cisplatin 60 mg/m² on day 1 and etoposide 120 mg/m² on days 1, 2, and 3

Four cycles of therapy are recommended with a planned cycle length of 21 to 28 days. In patients who are receiving both chemotherapy and radiation therapy, cisplatin + etoposide is the preferred treatment regimen. It is important to note that the NCCN recommends avoiding the use of myeloid growth factors (granulocyte-macrophage colony-stimulating factor [GM-CSF]) during concurrent treatment with chemotherapy and radiation therapy. 

The NCCN also recommends a lower-dose regimen of cisplatin and etoposide (cisplatin 25 mg/m² and etoposide 100 mg/m² both administered on days 1, 2, and 3) as another treatment option. Carboplatin at area under the curve (AUC) 5 to 6 on day 1 and etoposide 100 mg/m² on days 1, 2, and 3 may also be used.

Extensive-Stage SCLC

Patients with extensive-stage SCLC have both localized disease and distant metastases.¹ The programmed death-1/programmed death ligand-1 (PD-1/PD-L1) axis is responsible for shielding cancer cells from the immune system, allowing them to evade destruction and continue to spread. Monoclonal antibody agents designed to target both PD-1 on immune cells and PD-L1 on immune cells and tumor cells have proven invaluable in treating lung cancer.⁸

Studies demonstrate that immune checkpoint inhibitors targeting the PD-1/PD-L1 axis are an effective first-line treatment strategy for patients with extensive-stage SCLC. Specifically, the PD-L1 inhibitors atezolizumab and durvalumab have been found to improve progression-free survival and overall survival when administered with platinum-based chemotherapy and etoposide.^9,10 

Preferred First-Line Treatments for Extensive-Stage SCLC

The preferred first-line treatment regimens with atezolizumab for extensive-stage SCLC include:

• Carboplatin AUC 5 on day 1; etoposide 100 mg/m² on days 1, 2, and 3; and atezolizumab 1200 mg on day 1 cycled every 21 days for 4 cycles total, followed by atezolizumab 1200 mg maintenance on day 1 cycled every 21 days
• Carboplatin AUC 5 on day 1; etoposide 100 mg/m² on days 1, 2, and 3; and atezolizumab 1200 mg on day 1 cycled every 21 days for 4 cycles total followed by atezolizumab 1680 mg maintenance on day 1 cycled every 28 days

The preferred first-line treatment regimens with durvalumab for extensive-stage SCLC include:

• Cisplatin 75 to 80 mg/m² on day 1; etoposide 80 to 100 mg/m² on days 1, 2, and 3; and durvalumab 1500 mg on day 1 cycled every 21 days for 4 cycles total, followed by durvalumab 1500 mg maintenance on day 1 cycled every 28 days
• Carboplatin AUC 5 to 6 on day 1; etoposide 100 mg/m² on days 1, 2, and 3; and durvalumab 1500 mg on day 1 cycled every 21 days for 4 cycles total, followed by durvalumab 1500 mg maintenance on day 1 cycled every 28 days

It should be noted that contraindications to immunotherapy regimens including PD-1/PD-L1 inhibitors include active or previously diagnosed autoimmune disease and/or concurrent use of immunosuppressant agents. 

Other Recommended Therapies for Extensive-Stage SCLC

Other recommended treatment options from the NCCN for extensive-stage SCLC include:

• Cisplatin 25 mg/m² on days 1, 2, and 3 and etoposide 100 mg/m² on days 1, 2, and 3
• Cisplatin 75 mg/m² on day 1 and etoposide 100 mg/m² on days 1, 2, and 3
• Cisplatin 80 mg/m² on day 1 and etoposide 80 mg/m² on days 1, 2, and 3
• Carboplatin AUC 5 to 6 on day 1 and etoposide 100 mg/m² on days 1, 2, and 3

In certain circumstances, patients may be treated with a combination of carboplatin and irinotecan. The following dosing regimens are recommended by the NCCN:

• Cisplatin 30 mg/m² and irinotecan 65 mg/m² both on days 1 and 8
• Cisplatin 60 mg/m² on day 1 and irinotecan 60 mg/m² on days 1, 8, and 15
• Carboplatin AUC 5 on day 1 and irinotecan 50 mg/m² on days 1, 8, and 15

Like those with limited-stage disease, patients with extensive-stage disease are also recommended to receive 4 cycles of systemic therapy, but some patients may be eligible to receive 6 cycles if they responded well to treatment and have continued to tolerate it. Clinical trials demonstrate that maintenance or consolidation chemotherapy following initial treatment provides only minor benefits in extending the duration of response.^11,12 However, there is little to no impact on survival and there is an increased risk of toxicity that brings such treatment out of favor with the NCCN. 

Subsequent Pharmacologic Treatment Recommendations for SCLC

Although nearly all patients with SCLC initially respond to treatment, most eventually relapse with resistant disease.^1,2 Patients should be monitored every 2 to 6 months for relapse, particularly within the first 1 to 2 years following diagnosis of SCLC. Magnetic resonance imaging (MRI) or computed tomography (CT) imaging of the brain should be performed every 3 to 4 months in the first year following diagnosis of SCLC. 

The NCCN provides treatment recommendations regarding subsequent systemic therapy following relapse of SCLC. Many patients receive subsequent treatment as palliative care, and it can offer relief from the symptoms of SCLC. Fewer than 10% of patients who experience relapse within 6 months of beginning initial treatment will respond to subsequent treatment. If the time to relapse is greater than 6 months, the expected response rate is approximately 25%.^13,14 

During treatment with subsequent systemic therapies, patients should be monitored after every 2 to 3 cycles are completed. Studies have not yet identified an optimal duration for subsequent systemic therapy for SCLC. The NCCN recommends treating patients until unacceptable toxicity develops — which is a common strategy when using cytotoxic chemotherapy — or until disease progression. 

The preferred first-line subsequent systemic therapy for SCLC is platinum-based doublet chemotherapy. Physicians may rechallenge with the original regimen of cisplatin + etoposide or carboplatin + etoposide used in an adjuvant setting or for limited-stage SCLC. 

Other recommended second-line treatments and regimens provided by the NCCN for relapsed SCLC include several other chemotherapies and monoclonal antibody agents. 

Lurbinectedin

Lurbinectedin is a chemotherapy that inhibits oncogenic transcription by inducing double-strand DNA breaks and blocking polymerase activity. As a result, tumor cells are forced to undergo apoptosis.¹⁵ In clinical trials, the response rate to lurbinectedin treatment was 45% in patients who had not received chemotherapy for at least 90 days and 22% in those who had received chemotherapy within the same time interval.¹⁶ 

Topotecan

Topotecan is a topoisomerase inhibitor that blocks DNA replication by creating covalent bonds and inducing double-strand breaks.¹⁷ Topotecan is as effective as a single agent as it is in combination with chemotherapy treatment and is associated with fewer side effects.¹⁸ 

PD-1 Inhibitors

Nivolumab and pembrolizumab are PD-1 inhibitors that activate a patient’s immune system against their tumor cells.⁸ In clinical trials, treatment with nivolumab improved overall survival rates when compared with treatment with topotecan or amrubicin.¹⁹ The KEYNOTE-028 (ClinicalTrials.gov Identifier: NCT02054806) and KEYNOTE-158 (ClinicalTrials.gov Identifier: NCT02628067) studies evaluated pembrolizumab in patients with relapsed SCLC after 2 or more prior lines of therapy. The response rate to pembrolizumab was 19.3% and median overall survival was 7.7 months.²⁰ 

The US Food and Drug Administration (FDA) no longer indicates nivolumab or pembrolizumab as subsequent therapy for relapsed SCLC, as the clinical trials did not show significant improvements in overall survival.¹ However, the NCCN SCLC Panel still advises that these treatments may be effective in subsets of patients. For example, patients who do not receive atezolizumab or durvalumab and experience relapse after treatment for limited-stage disease are candidates for PD-1-inhibitor therapy. The NCCN SCLC Panel also notes that patients who have experienced disease progression while on maintenance atezolizumab or durvalumab are not recommended to receive nivolumab.

Other Chemotherapy Agents

The NCCN treatment guidelines provide evidence to support the use of paclitaxel, oral etoposide, gemcitabine temozolomide, vinorelbine, and bendamustine as single agents to treat relapsed SCLC. However, the guidelines note that clinical trials are a preferred option before any of these treatments are recommended. Clinical trials allow patients to gain access to experimental therapies and a higher level of care under the supervision of study staff. For cancer with poor outcomes, including SCLC, clinical trials offer patients another option to extend their lifespan and alleviate some of their disease burden. 

Table 1. Management Guidelines for Subsequent Systemic Therapies for Small Cell Lung Cancer

Drugs	Dosage	Administration
Bendamustine	120 mg/m2 on days 1 and 2 of a 21-d cycle for up to 6 cycles total	IV infusion with ESAs and G-CSF as needed
Cyclophosphamide + doxorubicin + vincristine (CAV)	Cyclophosphamide 1000 mg/m2, doxorubicin 45 mg/m2, and vincristine 2 mg on day 1 of a 21-d cycle	IV infusion
Docetaxel	120 mg/m2 on day 1 of a 21-d cycle	IV infusion over 1 h
Etoposide	50 mg/m2/d for 21 consecutive days	Orally as a capsule
Gemcitabine	1000 mg/m2 on days 1, 8, and 15 of a 28-d cycle	IV infusion over 30 min
Irinotecan	100 mg/m2 on days 1 and 8 of a 21-d cycle until disease progresses	IV infusion
Lurbinectedin	3.2 mg/m2 every 3 wk until unacceptable toxicity occurs or disease progresses	IV infusion over 1 h
Nivolumab	3 mg/kg every 2 wk until unacceptable toxicity occurs or disease progresses	IV infusion
Paclitaxel	175 mg/m2 every 3 wk	IV infusion over 3 h
Pembrolizumab	10 mg/kg every 2 wk or 200 mg every 3 wk for up to 2 y	IV infusion
Temozolomide	75 mg/m2/d for 21 or 28 days or 200 mg/m2/d for 5 consecutive days of a 28-d cycle	Orally as a capsule
Topotecan	(a) 2.3 mg/m2/d or (b) 1.5 mg/m2/d on days 1-5 of a 21-d cycle	(a) Orally as a capsule or (b) IV infusion
Vinorelbine	30 mg/m2 weekly	IV infusion

ESA = erythropoiesis-stimulating agent; G-CSF = granulocyte colony-stimulating factor; IV = intravenous.

From NCCN Treatment Guidelines and literature.^1,18,21-32

Treating Older Adults With SCLC

SCLC tends to be a disease of older adults, with a median age at diagnosis of older than 70 years.¹ Many geriatric patients have comorbid conditions or take several medications that could interfere with their tolerance and response to SCLC therapies. Patients in this age group are also more likely to experience fatigue, myelosuppression, and other complications compared with younger patients.^1,33 

The NCCN notes that older patients tend to have the same prognosis as their younger counterparts with stage-matched SCLC. However, extra care must be taken to avoid unnecessary toxicity and injury. Studies demonstrate that less-intensive, single-agent chemotherapies are not as effective as combination regimens. Chemotherapy and radiation therapy together also improve survival compared with chemotherapy alone. 

Older patients may be treated with 4 cycles of carboplatin + etoposide. Carboplatin is dosed using the AUC, which takes into account a patient’s renal function. Oftentimes, older adults have compromised renal function, which can interfere with drug dosing and result in unwanted toxicity and adverse events.¹ 

Monitoring Side Effects, Adverse Events, and Drug-Drug Interactions for Small Cell Lung Cancer Treatments

When treating patients with cytotoxic chemotherapy agents or immune checkpoint inhibitors, it is imperative to monitor them closely and adjust their medication dosages as needed. The ultimate goal of treatment is to strike a balance between a high enough dose to be effective while also limiting toxicity and unwanted side effects. 

Chemotherapy drugs often exhibit off-target effects due to their mechanisms of action. Many of them target rapidly dividing cells, and although this characteristic is invaluable for targeting SCLC tumor cells with rapid doubling times, chemotherapies may also harm the body’s healthy cells that also replicate quickly. Many patients experience gastrointestinal symptoms, low blood cell counts, and alopecia as a result of chemotherapy treatment.³⁴ 

Immune checkpoint inhibitors present unique immune-mediated side effects that are typically not caused by traditional cytotoxic chemotherapy drugs.¹ This class of drugs is associated with a greater risk of infusion-related reactions and, in rare cases, severe and even fatal adverse reactions. It is important to monitor a patient’s liver enzymes, thyroid function, and creatinine levels throughout treatment. 

Table 2. Side Effect Profiles of Recommended Treatments for Small Cell Lung Cancer

Drug	Most Common Adverse Events	Drug-Drug Interactions	Special Population Considerations
Atezolizumab	Alopecia, cough, decreased appetite, dyspnea, fatigue Warnings: Immune-related reactions, infusion-related reaction	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Bendamustine	Anorexia, constipation, cough, cytopenias, fatigue and weakness, pyrexia, headache, nausea, rash, shortness of breath, vomiting, weight loss Warnings: Infusion reaction or anaphylaxis, myelosuppression, serious infections, severe dermatologic reactions, TLS	CYP1A2 inhibitors or inducers	May be harmful to fetus; avoid using in breastfeeding patients
Carboplatin	Abdominal pain, back pain, constipation, cough, decreased appetite, diarrhea, fatigue and weakness, pyrexia, headache, joint pain, musculoskeletal pain, nausea, rash, upper respiratory tract infection, vomiting Warnings: Infusion reaction	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Cisplatin	Infections, myelosuppression, nausea, peripheral neuropathy, pyrexia, vomiting Warnings: Injection site reaction, nephrotoxicity, ocular toxicity, ototoxicity, secondary leukemia	Nephrotoxic and ototoxic drugs	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in patients with renal impairment
Cyclophosphamide	Abdominal pain, alopecia, anorexia, cytopenias, diarrhea, nausea, skin rash, vomiting Warnings: Cardiotoxicity, renal and urinary tract toxicity, hyponatremia, immunosuppression, impaired wound healing, infertility, myelosuppression, pulmonary toxicity, secondary malignancies, veno-occlusive liver disease	ACE inhibitors; amiodarone; amphotericin; anthracyclines; azathioprine; busulfan; coumarins; cyclosporine; cytarabine; etanercept; G-CSF; GM-CSF; indomethacin; metronidazole; natalizumab; paclitaxel; pentostatin; protease inhibitors; tamoxifen; thiazide diuretics; trastuzumab	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in geriatric patients and those with severe renal or hepatic impairment
Docetaxel	Alopecia, anorexia, cytopenias, neuropathy, dysgeusia, dyspnea, infections, myalgia, nail disorders, skin reactions Warnings: Colitis, eye disorders, hepatic impairment, hypersensitivity, skin reactions, neurologic reactions	CYP3A4 inhibitors or inducers	May be harmful to fetus; avoid using in breastfeeding patients; patients with severe hepatic impairment should not be treated with docetaxel
Doxorubicin	Alopecia, asthenia, chills, nausea, pyrexia, urticaria, vomiting Warnings: Cardiotoxicity, hepatotoxicity, immunosuppression and increased risk of infection, injection site reaction, secondary leukemia	Concomitant use of 6-mercaptopurine, dexrazoxane, or trastuzumab; CYP3A4, CYP2D6, and P-gp inhibitors or inducers	May be harmful to fetus; avoid using in breastfeeding patients; reduce dose in patients with severe hepatic impairment
Durvalumab	Abdominal pain, cough, diarrhea, dyspnea, fatigue, infections, pruritus, pyrexia, rash Warnings: Immune-related reactions, infusion-related reaction	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Etoposide	Abdominal pain, constipation, dysphagia, nausea, pyrexia, vomiting, neutropenia Warnings: Anaphylaxis, myelosuppression, optic neuritis, secondary leukemias	Warfarin	May be harmful to fetus; avoid using in breastfeeding patients
Gemcitabine	Cytopenias, dyspnea, elevated liver enzymes, nausea, proteinuria, skin rashes, vomiting Warnings: Hemolytic uremic syndrome, myelosuppression, pulmonary and hepatic toxicity	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Irinotecan	Abdominal pain, alopecia, anorexia, asthenia, constipation, cytopenias, diarrhea, nausea, pyrexia, vomiting, weight loss Warnings: Cholinergic reactions and diarrhea, hypersensitivity, increased toxicity in patients with performance status 2, increased risk of neutropenia in patients with reduced UGT1A1 activity, myelosuppression, pulmonary toxicity, renal impairment/failure	Leucovorin; strong CYP3A4 or UGT1A1 inhibitors; strong CYP3A4 inducers; 5-fluorouracil	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in geriatric patients and monitor them closely; use with caution in patients with hepatic impairment
Lurbinectedin	Constipation, cough, cytopenias, decreased albumin, decreased appetite, decreased magnesium, decreased sodium, diarrhea, dyspnea, fatigue, increased creatinine, increased glucose, increased liver enzymes, musculoskeletal pain, nausea, vomiting Warnings: Extravasation resulting in tissue necrosis, hepatotoxicity, myelosuppression, rhabdomyolysis	Moderate or strong CYP3A inhibitors or inducers	May be harmful to fetus; avoid using in breastfeeding patients
Nivolumab	Abdominal pain, back pain, decreased appetite, diarrhea, nausea, fatigue and weakness, pyrexia, headache, musculoskeletal pain, nausea, skin itching and rash, upper respiratory tract infection, urinary tract infection, vomiting Warnings: Anaphylaxis, immune-mediated reactions, infusion-related reaction	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Paclitaxel	Arthralgia, cytopenias, diarrhea, elevated liver enzyme levels, infections, myalgia, nausea, vomiting Warnings: Bradycardia, hypersensitivity, hypotension	CYP2C8 and CPY3A4 inhibitors and inducers	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in geriatric patients
Pembrolizumab	Abdominal pain, alopecia, arthralgia, cough, decreased appetite, fatigue, headache, insomnia, myalgia, peripheral neuropathy, pyrexia, skin rash, stomatitis  Warnings: Severe immune-related reactions, infusion reactions	None indicated	May be harmful to fetus; avoid using in breastfeeding patients
Temozolomide	Alopecia, fatigue, nausea, vomiting Warnings: Hepatotoxicty, myelosuppression, pneumocystis pneumonia, secondary MDS/AML	None indicated	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in geriatric patients, as they may develop serious thrombocytopenia or neutropenia in the first treatment cycle
Topotecan	Abdominal pain, asthenia, cytopenias, dyspnea, fatigue, nausea, pain, pneumonia, sepsis Warnings: Extravasation and tissue injury, ILD, myelosuppression	None indicated	May be harmful to fetus; avoid using in breastfeeding patients; reduce dosing in patients with creatinine clearance of 20-39 mL/min; no dose adjustments need to be made for patients with creatinine clearance ≥40 mL/min
Vincristine	Anemia, constipation, decreased appetite, diarrhea, fatigue, febrile neutropenia, insomnia, nausea, peripheral neuropathy, pyrexia Warnings: Extravasation tissue injury, hepatic toxicity, myelosuppression, neurotoxicity, severe constipation and bowel obstruction, TLS	Strong CYP3A inhibitors or inducers; P-gp inhibitors or inducers	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in patients with hepatic impairment
Vinorelbine	Cytopenias, elevated liver enzymes, nausea, peripheral neuropathy, vomiting, injection site reaction Warnings: Bowel obstruction from severe constipation; extravasation; myelosuppression; neurologic, hepatic, and pulmonary toxicity	CYP3A inhibitors	May be harmful to fetus; avoid using in breastfeeding patients; use with caution in patients with hepatic impairment

ACE = angiotensin converting enzyme; AML = acute myeloid leukemia; G-CSF = granulocyte colony-stimulating factor; GM-CSF = granulocyte-macrophage colony-stimulating factor; ILD = interstitial lung disease; MDS = myelodysplastic syndrome; P-gp = P-glycoprotein; TLS = tumor lysis syndrome; uridine diphosphate-glucuronosyl transferase 1A1.

From FDA-approved prescribing information.^35-55

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Author Bio

Emily Wagner, MS, earned a Bachelor of Science in biotechnology from the Rochester Institute of Technology in 2018 and a Master of Science in biomedical sciences with a focus in pharmacology from the University of Colorado Anschutz Medical Campus in 2020. During her thesis work, she studied non-small cell lung cancer and how the immune system plays a role in response to different treatments. Emily currently lives in Colorado where she enjoys the mountains, spending time with her dog, baking, and reading a good book.