Systemic Therapy for Small Cell Lung Cancer

Publication Date: November 20, 2024
Last Updated: December 12, 2024

Treatment

Recommendation 1.1

Adjuvant chemotherapy should be offered to patients with resected limited-stage SCLC who have adequate performance status. (EB, B, L, S)
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Recommendation 1.2

Adjuvant chemotherapy should consist of 4 cycles of cisplatin or carboplatin plus etoposide. (IC, B, , W)
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Recommendation 1.3

Adjuvant chemotherapy should be initiated within 8 weeks from resection. (IC, B, , W)
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Recommendation 2.1

Cisplatin and etoposide should be administered with concurrent radiotherapy in patients with LS-SCLC. (EB, B, H, S)
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Recommendation 2.2

Carboplatin and etoposide may be offered as systemic therapy concurrent with radiation for patients with LS-SCLC and contraindications to the use of cisplatin. (EB, B, L, S)
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Recommendation 2.3

Chemotherapy should be commenced as soon as possible in patients with LS-SCLC and not deferred until radiation therapy can be started. (IC, B, L, S)
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Recommendation 2.4.

(New): Patients with LS-SCLC who have completed concurrent chemoradiotherapy and do not have disease progression should be offered consolidation immunotherapy (durvalumab) for up to 2 years if there are no contraindications to immunotherapy. (, , M, S)
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Recommendation 3.1

First-line systemic therapy with carboplatin or cisplatin plus etoposide plus immunotherapy (atezolizumab or durvalumab) followed by maintenance immunotherapy should be offered to patients with ES-SCLC if there are no contraindications to immunotherapy. (EB, B, H, S)
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Recommendation 4.1

(New): In patients with relapsed SCLC with a chemotherapy-free interval of less than 90 days, single-agent systemic therapy may be offered. Preferred agents are topotecan, lurbinectedin, or tarlatamab. (, , M, S)
Qualifying statement: Single-agent systemic therapy is preferred over multi-agent systemic therapies due to concerns regarding the balance of risks versus benefits.
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Recommendation 4.2

(New): In patients with relapsed SCLC with a chemotherapy-free interval of at least 90 days, re-challenge with a platinum-based regimen or single-agent systemic therapy (preferred agents are topotecan, lurbinectedin, or tarlatamab) may be offered. (, , M, S)
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Recommendation 4.3

In patients with relapsed SCLC who had progression while on maintenance immunotherapy, there is no evidence to support continuation of immunotherapy. (IC, , , S)
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Recommendation 4.4

In an immunotherapy-naïve patient, second-line immunotherapy alone is not recommended outside of the clinical trial setting. Participation in clinical trials to better identify predictive biomarkers is encouraged. (EB, B/H, M, S)
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Recommendation 5.1

Elderly patients with LS-SCLC and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–1 may be offered standard treatment with concurrent chemoradiotherapy with curative intent. (EB, B, M, S)
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Recommendation 5.2

Patients with LS-SCLC and ECOG PS 2 due to SCLC may be offered standard treatment with concurrent chemoradiotherapy with curative intent. (EB, B, L, W)
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Recommendation 5.3

Patients with LS-SCLC and ECOG PS 3–4 due to SCLC may be offered initial chemotherapy followed by sequential radiotherapy if there is improvement in PS. (IC, B, L, W)
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Recommendation 5.3.1

(New): Patients with LS-SCLC and ECOG PS 3-4 due to SCLC who have been treated with concurrent or sequential chemotherapy and radiotherapy may be offered consolidation immunotherapy (durvalumab) for up to 2 years if there are no contraindications to immunotherapy and there is improvement in PS. (, , L, C)
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Recommendation 5.4

Elderly patients with ES-SCLC and ECOG PS 0–1 may be offered standard treatment with carboplatin and etoposide plus immunotherapy (atezolizumab or durvalumab) followed by maintenance immunotherapy. (EB, B, M, S)
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Recommendation 5.5

Patients with ES-SCLC and ECOG PS 2 may be offered carboplatin and etoposide plus immunotherapy. (IC, B, L, W)
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Recommendation 5.6

Patients with ES-SCLC and ECOG PS 3–4 due to SCLC may be offered chemotherapy. (IC, B, L, W)
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Recommendation 6.1

Patients with non-small cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation that has transformed to SCLC should be managed with carboplatin or cisplatin plus etoposide. (IC, B, L, W)
Qualifying statement: There is insufficient evidence to support the use of immunotherapy in this setting. Clinical trial enrollment should be offered whenever possible.
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Recommendation 6.2

EGFR inhibitor may be continued with chemotherapy in patients with NSCLC harboring an EGFR mutation that has transformed to SCLC. (IC, B, L, W)
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Recommendation 7.1

There is no evidence to support the use of molecular profiling and biomarker analysis to guide standard treatment in patients with de novo SCLC. (EB, , L, W)
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Recommendation 8.1

Trilaciclib or granulocyte colony stimulating factor (G-CSF) may be offered as a myeloid supportive agent for patients with untreated or previously treated ES-SCLC who are undergoing treatment with chemotherapy or chemoimmunotherapy. (EB, B, M, W)
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Recommendation 8.2

G-CSF may be offered in patients with LS-SCLC who are undergoing chemoradiotherapy. (EB, B, M, W)
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Systemic Therapy for Small Cell Lung Cancer

Authoring Organization

American Society of Clinical Oncology

Publication Month/Year

November 20, 2024

Last Updated Month/Year

December 12, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer.

Target Patient Population

Patients with small cell lung carcinoma

Target Provider Population

Medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, pathologists, radiologists, primary care physicians, nurse practitioners, physician assistants, pharmacists, nurses, and other providers.

PICO Questions

  1. What is the optimal treatment regimen for adjuvant systemic therapy in patients with resected SCLC?

  2. What is the optimal systemic therapy for use with concurrent radiotherapy in patients with LS-SCLC?

  3. What is the optimal first-line systemic therapy for patients with ES-SCLC?

  4. What systemic therapy options are available for treating relapsed SCLC?

  5. What is the best management approach for treatment-naïve patients who are older or who have poor performance status (PS)?

  6. What is the optimal systemic therapy for patients with non–small-cell lung cancer (NSCLC) harboring an epidermal growth factor receptor (EGFR) mutation that has transformed to SCLC?

  7. What is the role of biomarkers, including molecular profiling in guiding therapy for patients with SCLC?

  8. Which myeloid supportive agents may be considered for use in patients with SCLC?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D008175 - Lung Neoplasms, D055752 - Small Cell Lung Carcinoma, D018288 - Carcinoma, Small Cell

Keywords

Cancer immunotherapy, small cell lung cancer (SCLC), LS-SCLC, ES-SCLC, limited-stage small cell lung cancer, extensive-stage small cell lung cancer, EGFR mutation, NSCLC with EGFR mutation, SCLC immunotherapy, small cell lung cancer immunotherapy, Systemic Therapy for SCLC, relapsed SCLC, EGFR-mutant NSCLC Transformed to SCLC

Source Citation

Khurshid H, Ismaila N, Bian J, et al. Systemic Therapy for SCLC: ASCO-OH Guideline Rapid Recommendation Update. J Clin Oncol. 2024 Nov 20. doi:10.1200/JCO.24.02245

Khurshid H, Ismaila N, Bian J, et al. Systemic Therapy for SCLC: ASCO-OH Guideline. J Clin Oncol. 2023 Oct 11. doi:10.1200/JCO.23.01435

Supplemental Methodology Resources

Data Supplement, Evidence Tables

Methodology

Number of Source Documents
196
Literature Search Start Date
December 31, 1989
Literature Search End Date
July 31, 2022