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
Treatmen...
...ecommendation 1.1Adjuvant chemotherapy should...
...ommendation 1.2Adjuvant chemotherapy should...
...dation 1.3Adjuvant chemotherapy shoul...
...dation 2.1Cisplatin and etoposide should be admi...
...n 2.2Carboplatin and etoposide may be of...
...2.3Chemotherapy should be commenced as...
...mmendation 3.1First-line systemic t...
...ommendation 4.1In patients with relap...
...4.2In patients with relapsed SCLC...
...on 4.3In patients with relapsed SCLC who...
...4.4In an immunotherapy-naïve patient, seco...
...commendation 5.1Elderly patients with...
....2Patients with LS-SCLC and ECOG PS 2 due to SCLC...
...n 5.3Patients with LS-SCLC and ECOG...
...5.4Elderly patients with ES-SCLC and ECOG PS 0...
...dation 5.5Patients with ES-SCLC and ECOG PS 2 m...
...tion 5.6Patients with ES-SCLC and ECOG...
...endation 6.1Patients with non-small cell...
...ation 6.2EGFR inhibitor may be continued with che...
...7.1There is no evidence to support...
...ation 8.1Trilaciclib or granulocyte colony stimu...
...ndation 8.2G-CSF may be offered in patients with...
...efer to the treatment algorithm in Figures...
Figure 1. Systemic Therapy for SCLC1 May use tr...
...ic Therapy for Relapsed SCLC1 May use tril...
Figure 3. Systemic Therapy for EGFR-...
...ASCO believes that cancer clinical trials...