Systemic Therapy for Small Cell Lung Cancer
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
...reatme...
Recommendation 1.1Adjuvant chemotherapy...
...1.2Adjuvant chemotherapy should cons...
...ation 1.3Adjuvant chemotherapy should be init...
...ecommendation 2.1Cisplatin and etoposide should b...
...n 2.2Carboplatin and etoposide may be off...
...ation 2.3Chemotherapy should be commenced as...
....1First-line systemic therapy with carboplati...
...endation 4.1In patients with relapse...
...dation 4.2In patients with relapse...
...ecommendation 4.3In patients with relapsed SCLC...
...4.4In an immunotherapy-naïve patie...
...endation 5.1Elderly patients with LS-SCLC a...
...mendation 5.2Patients with LS-SCLC and...
....3Patients with LS-SCLC and ECOG PS 3–4 d...
...tion 5.4Elderly patients with ES-SCLC and ECO...
...ecommendation 5.5Patients with ES-SCLC and E...
...ommendation 5.6Patients with ES-SCLC and...
...n 6.1Patients with non-small cell lung cancer...
...commendation 6.2EGFR inhibitor may be continued...
...mendation 7.1There is no evidence t...
...dation 8.1Trilaciclib or granulocyte colony st...
...ndation 8.2G-CSF may be offered in patients...
...ase refer to the treatment algorithm in...
...Systemic Therapy for SCLC1 May use tr...
...ure 2. Systemic Therapy for Relapsed SCLC1 Ma...
...stemic Therapy for EGFR-mutant NSCLC...
...eves that cancer clinical trials are vital to i...