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...

...ecommendation 1.1Adjuvant chemotherapy sh...


...1.2Adjuvant chemotherapy should cons...


...mendation 1.3Adjuvant chemotherapy should...


....1Cisplatin and etoposide should be administ...


...mmendation 2.2Carboplatin and etoposide may be o...


...dation 2.3Chemotherapy should be commenced...


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


...ation 4.1In patients with relapsed...


...mmendation 4.2In patients with relapsed...


...commendation 4.3In patients with relapsed...


...mendation 4.4In an immunotherapy-naïv...


...ommendation 5.1Elderly patients with...


...ndation 5.2Patients with LS-SCLC and ECOG...


...commendation 5.3Patients with LS-SCLC and...


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


...ion 5.5Patients with ES-SCLC and ECOG P...


...tion 5.6Patients with ES-SCLC and ECOG PS...


...endation 6.1Patients with non-small cell...


...6.2EGFR inhibitor may be continued with chemothe...


...ation 7.1There is no evidence to support the use o...


...ation 8.1Trilaciclib or granulocyte co...


...dation 8.2G-CSF may be offered in patients wi...


...the treatment algorithm in Figures 1 to 3 for...


...ic Therapy for SCLC1 May use trila...


...ystemic Therapy for Relapsed SCLC1 May use t...


Figure 3. Systemic Therapy for EGFR-mutant N...


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