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
Treatme...
...mendation 1.1Adjuvant chemotherapy should...
...ommendation 1.2Adjuvant chemotherapy s...
....3Adjuvant chemotherapy should be initiated...
...mendation 2.1Cisplatin and etoposide should be adm...
...ommendation 2.2Carboplatin and etoposi...
...2.3Chemotherapy should be commenced as soon...
...ecommendation 3.1First-line systemic therapy w...
...ndation 4.1In patients with relapsed SCLC wi...
...4.2In patients with relapsed SCLC w...
...dation 4.3In patients with relapsed...
...4.4In an immunotherapy-naïve patient, second-lin...
...mmendation 5.1Elderly patients with LS-SC...
...ndation 5.2Patients with LS-SCLC and ECOG PS 2 du...
...tion 5.3Patients with LS-SCLC and EC...
...endation 5.4Elderly patients with ES-SCLC and ECOG...
...commendation 5.5Patients with ES-SCLC and ECOG PS...
...tion 5.6Patients with ES-SCLC and ECOG PS 3â...
...ation 6.1Patients with non-small cell l...
...on 6.2EGFR inhibitor may be continued with chemoth...
...dation 7.1There is no evidence to support the u...
...8.1Trilaciclib or granulocyte colo...
...ion 8.2G-CSF may be offered in patients with LS-...
...o the treatment algorithm in Figures 1...
...1. Systemic Therapy for SCLC1 May use trilaci...
...gure 2. Systemic Therapy for Relapsed SCLC1...
...e 3. Systemic Therapy for EGFR-mutant NSC...
...ASCO believes that cancer clinica...