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
...reatmen...
...ommendation 1.1Adjuvant chemotherapy should be...
...1.2Adjuvant chemotherapy should consis...
...tion 1.3Adjuvant chemotherapy should be initia...
...on 2.1Cisplatin and etoposide should be ad...
...n 2.2Carboplatin and etoposide may be offer...
...on 2.3Chemotherapy should be commenc...
...tion 3.1First-line systemic therapy wit...
...on 4.1In patients with relapsed SCLC wi...
...dation 4.2In patients with relapsed SC...
...ommendation 4.3In patients with relapsed SCLC wh...
...ation 4.4In an immunotherapy-naïve...
...n 5.1Elderly patients with LS-SCLC and Eastern Coo...
...5.2Patients with LS-SCLC and ECOG PS 2 due...
...ecommendation 5.3Patients with LS-SCLC a...
...ion 5.4Elderly patients with ES-SCL...
...dation 5.5Patients with ES-SCLC and ECOG...
Recommendation 5.6Patients with ES-SCLC...
...6.1Patients with non-small cell lung cancer (NSCL...
...dation 6.2EGFR inhibitor may be continued w...
...endation 7.1There is no evidence to support...
...mmendation 8.1Trilaciclib or granulocyte colo...
...n 8.2G-CSF may be offered in patients wit...
...ease refer to the treatment algori...
...emic Therapy for SCLC1 May use trilaciclib or G-C...
...2. Systemic Therapy for Relapsed SCLC...
...temic Therapy for EGFR-mutant NSCLC Transforme...
...that cancer clinical trials are vital to inform...