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
...atment...
...ion 1.1Adjuvant chemotherapy should be offere...
...ndation 1.2Adjuvant chemotherapy s...
...n 1.3Adjuvant chemotherapy should be init...
Recommendation 2.1Cisplatin and etoposid...
...mmendation 2.2Carboplatin and etoposide may...
...on 2.3Chemotherapy should be commence...
...n 2.4.(New): Patients with LS-SCLC w...
...ion 3.1First-line systemic therapy with...
...ion 4.1(New): In patients with relaps...
...4.2(New): In patients with relapsed S...
...n 4.3In patients with relapsed SCLC who had pro...
...n 4.4In an immunotherapy-naïve patient, secon...
...endation 5.1Elderly patients with LS-SCLC and Eas...
...endation 5.2Patients with LS-SCLC and ECOG...
Recommendation 5.3Patients with LS-SCLC and E...
...tion 5.3.1(New): Patients with LS-SCL...
...mmendation 5.4Elderly patients with ES-SC...
...on 5.5Patients with ES-SCLC and ECOG PS 2 may...
...ion 5.6Patients with ES-SCLC and ECOG PS 3–...
...tion 6.1Patients with non-small cell lung cancer...
...dation 6.2EGFR inhibitor may be continued with...
...commendation 7.1There is no evidence...
...tion 8.1Trilaciclib or granulocyte...
...mendation 8.2G-CSF may be offered...
...ease refer to the treatment algorithm in Figures...
...stemic Therapy for SCLC1 May use trilac...
...emic Therapy for Relapsed SCLC1 May...
...3. Systemic Therapy for EGFR-mutant...
...es that cancer clinical trials are vital to in...