Table 3.
Treatment strategies for patients with small cell lung carcinoma.
| Stage of the Disease | Treatment Options |
|---|---|
| Limited | Lobectomy with mediastinal dissection for stage I or II disease after extensive staging |
| Adjuvant chemotherapy with cisplatin and etoposide for negative mediastinal lymph nodes and margins | |
| Chemoradiotherapy for positive mediastinal lymph nodes or R1–R2 margins | |
| Prophylactic cranial radiotherapy (PCI) in case of response to therapy | |
| The preferred regimen for chemoradiotherapy: Cisplatin 75 mg/m2 day one and etoposide 100 to 120 mg/m2 day 1–3 |
|
| External radiotherapy in a total dose of 45 Gy twice daily (BID) | |
| A total radiotherapy dose of 60 Gy once daily is not inferior to 45 Gy BID (CONVERT study) | |
| Extensive-stage: First-line |
Chemoimmunotherapy with atezolizumab or durvalumab in combination with platinum-based chemotherapy |
| Carboplatin or cisplatin in combination with etoposide | |
| Consolidation radiotherapy of the lung and prophylactic cranial irradiation (PCI) or MRI brain surveillance if there is a response to chemotherapy | |
| Extensive-stage: Second-line |
Platinum reinitiation in platinum-sensitive disease |
| Chemotherapy (topotecan, CAV protocol, irinotecan, gemcitabine, temozolomide, docetaxel) | |
| Lurbinectedin (for platinum-sensitive or resistant disease relapse) | |
| Extensive-stage: Second line or beyond |
New emerging therapeutic strategies under investigation (Aurora kinase A inhibitor, poly ADP ribose polymerase (PARP) inhibitor, ataxia telangiectasia, and Rad3 related (ATR) kinase inhibitor, Checkpoint kinase 1 (CHK1) inhibitor, Delta-like ligand 3 (DLL3) inhibitor, MYC inhibitor, Ganglioside fucosyl-GM1, an inhibitor of the bromodomain (BRD) and extra-terminal domain (BET) family of proteins |
| Rovalpituzumab tesirine (not proven benefit in phase III randomized controlled trial) | |
| Tarlatamab (TMG 757)—DLL3-targeted bispecific T-Cell engager | |
| Olaparib (poly ADP ribose polymerase- PARP inhibitor) in combination with temozolomide | |
| Aurora kinase inhibitors (positive signals in patients with c-MYC expression SCLC) | |
| ATR inhibitor in combination with topotecan |