Treatment Options for Small Cell Lung Cancer by Stage

Small cell lung cancer is most recently being classified into stages in the same way that non-small cell lung cancer is. However, National Cancer Institute treatment guidelines still organize treatment options by whether the small cell lung cancer is limited to the lung or has spread more extensively:1

Limited-stage disease

  • Combination chemotherapy
  • Combination chemotherapy and external radiation therapy
  • Surgery, followed by chemotherapy or chemoradiotherapyTreatment that combines chemotherapy with radiation therapy
  • Radiation therapy to the brain for patients who have had a complete responseThe disappearance of all signs of cancer in response to treatment; this does not always mean the cancer has been cured, to prevent the spread of cancer to the brain; also known as prophylactic cranial irradiationRadiation therapy to the brain to reduce the risk of cancer spreading to that organ
  • Clinical trials of new chemotherapy, surgery, and radiation treatments

Extensive-stage disease

  • Combination chemotherapy
  • Radiation therapy to the brain, spine, bone, or other parts of the body where the cancer has spread, as palliative therapy to relieve symptoms and improve quality of life
  • Radiation therapy to the brain in patients who have had a complete response, to prevent the spread of cancer to the brain; also known as prophylactic cranial radiation
  • Immunotherapy—atezolizumab (Tecentriq®)—in combination with carboplatin (Paraplatin®) and etoposide (Etopophos®) for the first-line treatment of adult patients 2
  • Immunotherapy—nivolumab (Opdivo®)—for patients who have progressed after platinum-based chemotherapy and at least one other line of therapy3
  • Immunotherapy—pembrolizumab (Keytruda®)—for patients who have progressed on or after platinum-based chemotherapy and at least one other prior line of therapy4
  • Immunotherapy—pembrolizumab (Keytruda®)—for the treatment of adult and pediatric patients with unresectable or metastatic solid tumors with a high TMB (tissue mutational burden); these include small cell lung cancer tumors7
  • Immunotherapy—durvalumab (Imfinzi®)—for first-line treatment of adult patients with extensive-stage small cell lung cancer, in combination with etoposide and either carboplatin or cisplatin5
  • Alkylating drug  (a form of chemotherapy)—lurbinectedin (ZepzelcaTM )—for patients who have progressed on or after platinum-based chemotherapy6
  • Clinical trials of new treatment options

Recurrent disease

  • Chemotherapy
  • Radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Laser therapy, stent placement to keep airways open, and/or internal radiation therapy as palliative therapy to relieve symptoms and improve quality of life
  • Immunotherapy—nivolumab (Opdivo®)—for patients who have progressed after platinum-based chemotherapy and at least one other line of therapy3
  • Clinical trial options with new drugs

Updated June 18, 2020


References

1.  Small Cell Lung Cancer Treatment (PDQ®): Treatment Options by Stage. National Cancer Institute website. http://www.cancer.gov/types/lung/patient/small-cell-lung-treatment-pdq#link/_112. Updated November9, 2017. Accessed Decemeber 1, 2017.
2.   FDA approves atezolizumab for exensive-stage small cell lung cancer. US FDA website. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm633814.htm. POsted March 18, 2019. Accessed March 19, 2019.
3.   FDA grants nivolumab accelerated approval for third-line treatment of metastatic small cell lung cancer. US FDA website. https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm617370.htm?utm_campaign=Oncology%208%2F20%2F2018%20&utm_medium=email&utm_source=Eloqua&e.... Posted August 16, 2018. Accessed August 20, 2018.
4.  Keytruda® (pembrolizumab) injection [package insert]. 2014. Merck & Co., Whitehorse Station, NJ. https://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_pi.pdf. Updated June 2019. Accessed June 18, 2019.
5.  Imfinzi® (durvalumab) injection [package insert]. 2017. AstraZeneca. https://azpi..central.com/imfinzi/imfinzi.pdf. Revised March 2020. Accessed March 30, 2020.
6.  ZepzelcaTM (lurbinectedin injection [package insert]. 2020. Jazz Pharmaceuticals, Inc. Palo Alto, CA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213702s000lbl.pdf. Revised June 2020. Accessed June 16, 2020.
7. FDA approves pembrolizumab for adults and children with TMB-H solid tumors. US FDA website. https://www.fda.gov/drugs/drug-approvals-and-databases/fda-approves-pembrolizumab-adults-and-children-tmb-h-solid-tumors#:~:text=On%20June%2016%2C%202.... Posted June 17, 2020. Accessed June 18, 2020.

 

 

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