Systemic Therapy for Small Cell Lung Cancer
Publication Date: October 11, 2023
Last Updated: October 11, 2023
Treatment
Recommendation 1.1
Adjuvant chemotherapy should be offered to patients with resected limited-stage SCLC who have adequate performance status. (EB, B, L, S)
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Recommendation 1.2
Adjuvant chemotherapy should consist of 4 cycles of cisplatin or carboplatin plus etoposide. (IC, B, , W)
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Recommendation 1.3
Adjuvant chemotherapy should be initiated within 8 weeks from resection. (IC, B, , W)
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Recommendation 2.1
Cisplatin and etoposide should be administered with concurrent radiotherapy in patients with LS-SCLC. (EB, B, H, S)
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Recommendation 2.2
Carboplatin and etoposide may be offered as systemic therapy concurrent with radiation for patients with LS-SCLC and contraindications to the use of cisplatin. (EB, B, L, S)
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Recommendation 2.3
Chemotherapy should be commenced as soon as possible in patients with LS-SCLC and not deferred until radiation therapy can be started. (IC, B, L, S)
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Recommendation 3.1
First-line systemic therapy with carboplatin or cisplatin plus etoposide plus immunotherapy (atezolizumab or durvalumab) followed by maintenance immunotherapy should be offered to patients with ES-SCLC if there are no contraindications to immunotherapy. (EB, B, H, S)
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Recommendation 4.1
In patients with relapsed SCLC with a chemotherapy-free interval of less than 90 days, single-agent chemotherapy may be offered. Preferred agents are topotecan or lurbinectedin. (EB, B, M, S)
Qualifying statement: Single-agent chemotherapy is preferred over multi-agent chemotherapy due to concerns regarding the balance of risks versus benefits.
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Recommendation 4.2
In patients with relapsed SCLC with a chemotherapy-free interval of at least 90 days, re-challenge with a platinum-based regimen or single agent chemotherapy (preferred agents are topotecan or lurbinectedin) may be offered. (EB, B, M, S)
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Recommendation 4.3
In patients with relapsed SCLC who had progression while on maintenance immunotherapy, there is no evidence to support continuation of immunotherapy. (IC, , , S)
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Recommendation 4.4
In an immunotherapy-naïve patient, second-line immunotherapy alone is not recommended outside of the clinical trial setting. Participation in clinical trials to better identify predictive biomarkers is encouraged. (EB, B/H, M, S)
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Recommendation 5.1
Elderly patients with LS-SCLC and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–1 may be offered standard treatment with concurrent chemoradiotherapy with curative intent. (EB, B, M, S)
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Recommendation 5.2
Patients with LS-SCLC and ECOG PS 2 due to SCLC may be offered standard treatment with concurrent chemoradiotherapy with curative intent. (EB, B, L, W)
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Recommendation 5.3
Patients with LS-SCLC and ECOG PS 3–4 due to SCLC may be offered initial chemotherapy followed by sequential radiotherapy if there is improvement in PS. (IC, B, L, W)
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Recommendation 5.4
Elderly patients with ES-SCLC and ECOG PS 0–1 may be offered standard treatment with carboplatin and etoposide plus immunotherapy (atezolizumab or durvalumab) followed by maintenance immunotherapy. (EB, B, M, S)
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Recommendation 5.5
Patients with ES-SCLC and ECOG PS 2 may be offered carboplatin and etoposide plus immunotherapy. (IC, B, L, W)
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Recommendation 5.6
Patients with ES-SCLC and ECOG PS 3–4 due to SCLC may be offered chemotherapy. (IC, B, L, W)
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Recommendation 6.1
Patients with non-small cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation that has transformed to SCLC should be managed with carboplatin or cisplatin plus etoposide. (IC, B, L, W)
Qualifying statement: There is insufficient evidence to support the use of immunotherapy in this setting. Clinical trial enrollment should be offered whenever possible.
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Recommendation 6.2
EGFR inhibitor may be continued with chemotherapy in patients with NSCLC harboring an EGFR mutation that has transformed to SCLC. (IC, B, L, W)
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Recommendation 7.1
There is no evidence to support the use of molecular profiling and biomarker analysis to guide standard treatment in patients with de novo SCLC. (EB, , L, W)
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Recommendation 8.1
Trilaciclib or granulocyte colony stimulating factor (G-CSF) may be offered as a myeloid supportive agent for patients with untreated or previously treated ES-SCLC who are undergoing treatment with chemotherapy or chemoimmunotherapy. (EB, B, M, W)
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Recommendation 8.2
G-CSF may be offered in patients with LS-SCLC who are undergoing chemoradiotherapy. (EB, B, M, W)
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The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
Title
Systemic Therapy for Small Cell Lung Cancer
Authoring Organization
American Society of Clinical Oncology
Publication Month/Year
October 11, 2023
Last Updated Month/Year
November 6, 2023
Country of Publication
US
Target Patient Population
Patients with small cell lung carcinoma
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Treatment, Management
Diseases/Conditions (MeSH)
D008175 - Lung Neoplasms, D055752 - Small Cell Lung Carcinoma, D018288 - Carcinoma, Small Cell
Keywords
Cancer immunotherapy, small cell lung cancer (SCLC), LS-SCLC, ES-SCLC, limited-stage small cell lung cancer, extensive-stage small cell lung cancer, EGFR mutation, NSCLC with EGFR mutation, SCLC immunotherapy, small cell lung cancer immunotherapy, Systemic Therapy for SCLC, relapsed SCLC, EGFR-mutant NSCLC Transformed to SCLC
Source Citation
Khurshid H, Ismaila N, Bian J, et al. Systemic Therapy for SCLC: ASCO-OH Guideline. J Clin Oncol. 2023 Oct 11. doi:10.1200/JCO.23.01435
Methodology
Number of Source Documents
196
Literature Search Start Date
January 1, 1990
Literature Search End Date
August 1, 2022