Small Cell Lung Cancer (SCLC)

Background: 

• Poor prognosis. Median OS ~ 12-14 month

• Limited-Stage SCLC: confined to the ipsilateral hemithorax, which can be safely encompassed within a radiation field

• Extensive-Stage SCLC: metastatic, beyond the ipsilateral hemithorax, including malignant pleural or pericardial effusion

• May present with SVC Syndrome

  • IR consult - Ideally could still get tissue diagnosis before treating

  • Rad Onc consult for Emergent treatment with concurrent chemoRT

LS-SCLC Treatment

• Stage I-IIA (T1-2 only): lobectomy + adjuvant chemotherapy (Cisplatin and etoposide)

• Stage IIB-III: Concurrent chemo-RT

  • Consider post-chemo-RT consolidation Durvalumab (ADRIATIC) → OS was 55.9 months (durvalumab) vs 33.4 months (placebo). PFS was 16.6 months (durvalumab) vs 9.2 months (placebo).

• Consider prophylactic cranial irradiation (decreases brain metastases and increases OS)

ES-SCLC Treatment

• No radiation or surgery

• Consider MRI brain

• Combination chemo+ IO (IMPOWER-133, CASPIAN)

  •  (carboplatin/cisplatin + etoposide x4 cycles) + (Atezolizumab/Durvalumab)

• For brain metastases: start with WBRT + steroids

Relapsed SCLC Treatment

• Consider if platinum-resistant. Can re-challenge with Carboplatin + etoposide if relapse > 6 months after platinum exposure

• Lurbinectedin and Topotecan can be used in 2nd line if relapse < 6 months (chemo-refractory)

• Talratamab: bispecific Ab (DeLLphi-301)

• Clinical Trial

IN PROGRESS...