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

...reatme...

...ommendation 1.1Adjuvant chemotherapy shoul...


....2Adjuvant chemotherapy should consist of 4 c...


...dation 1.3Adjuvant chemotherapy should...


...ndation 2.1Cisplatin and etoposide should be...


Recommendation 2.2Carboplatin and etopo...


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


...ndation 3.1First-line systemic therapy with c...


...n 4.1In patients with relapsed SCLC with a chemot...


...ion 4.2In patients with relapsed SCLC with a chem...


...ommendation 4.3In patients with relapsed...


...endation 4.4In an immunotherapy-naï...


...5.1Elderly patients with LS-SCLC...


...ation 5.2Patients with LS-SCLC and E...


...tion 5.3Patients with LS-SCLC and ECOG PS 3–4...


...mendation 5.4Elderly patients with E...


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


....6Patients with ES-SCLC and ECOG PS...


...ion 6.1Patients with non-small cel...


...ecommendation 6.2EGFR inhibitor may be c...


...ation 7.1There is no evidence to support...


...ation 8.1Trilaciclib or granulocyte colo...


...tion 8.2G-CSF may be offered in patients...


...fer to the treatment algorithm in Figures 1 t...


...stemic Therapy for SCLC1 May use tr...


...e 2. Systemic Therapy for Relapsed SCLC1 May...


Figure 3. Systemic Therapy for EGFR-m...


...ASCO believes that cancer clinical trials...