Systemic Therapy for Small Cell Lung Cancer

Publication Date: October 11, 2023

Key Points

Key Points

  • Small cell lung cancer (SCLC) is an aggressive, poorly differentiated, neuroendocrine carcinoma with more than 150,000 people diagnosed worldwide each year.
    • Nearly all patients with SCLC have a history of cigarette use.
  • SCLC is usually staged using the Veterans Administration Lung Study Group staging system which defines limited-stage (LS-SCLC) as disease confined to one hemithorax within a tolerable radiation field, and extensive-stage (ES-SCLC) as disease extending beyond LS-SCLC, including malignant pleural effusion, contralateral lung involvement, and hematogenous metastases.
    • Over two-thirds of patients present with extensive-stage disease at diagnosis.
  • LS-SCLC is potentially curable when treated with concurrent chemoradiotherapy, with 5-year overall survival (OS) rates reported as up to 34%.
  • ES-SCLC remains an incurable disease with a 5-year OS rate of <5%.
  • Since the last ASCO update in SCLC management in 2015, there have now been significant advances in the systemic treatment of ES-SCLC with the incorporation of immune checkpoint inhibitors into first-line therapy, and additional options for subsequent treatment of recurrent disease.

Treatment

...Treatment...

Recommendation 1.1Adjuvant chemotherapy should...


...ecommendation 1.2Adjuvant chemotherapy s...


...mendation 1.3Adjuvant chemotherapy should be in...


...2.1Cisplatin and etoposide should be administered...


...ion 2.2Carboplatin and etoposide ma...


...2.3Chemotherapy should be commenced as so...


...3.1First-line systemic therapy with carbo...


...ommendation 4.1In patients with relapsed SC...


....2In patients with relapsed SCLC with a chemo...


Recommendation 4.3In patients with relap...


...tion 4.4In an immunotherapy-naïve patient, sec...


...mmendation 5.1Elderly patients with...


...mendation 5.2Patients with LS-SCLC an...


...on 5.3Patients with LS-SCLC and ECOG PS 3...


...commendation 5.4Elderly patients with ES-SCLC and...


...ecommendation 5.5Patients with ES-SCLC and ECOG...


...mendation 5.6Patients with ES-SCLC and ECOG...


...tion 6.1Patients with non-small cell lung cancer...


...ation 6.2EGFR inhibitor may be continued with c...


...tion 7.1There is no evidence to su...


...ation 8.1Trilaciclib or granulocyte colony s...


...on 8.2G-CSF may be offered in patients with L...


Please refer to the treatment algorithm in...


...ic Therapy for SCLC1 May use trilaciclib...


...mic Therapy for Relapsed SCLC1 May use tr...


...temic Therapy for EGFR-mutant NSCLC Transfor...


...believes that cancer clinical trial...