A narrative review of salvage therapy in small cell lung cancer

Abstract

: Small cell lung cancer (SCLC) is an aggressive subtype of lung cancer, responsible for a disproportionate number of lung cancer deaths. Most patients present with advanced disease, where systemic therapy is the primary treatment. While SCLC is initially sensitive to cytotoxic chemotherapy, responses are transient and upon relapse, SCLC is relatively refractory to therapy. The addition of immunotherapy to front-line treatment for SCLC has improved survival, but most patients will still have relapse of their disease and at that time, options are limited. Retreatment with platinum based chemotherapy remains a viable option for patients who have had a longer chemotherapy free interval. Topotecan and lurbinectedin are both cytotoxic agents that are approved in the second line setting as monotherapy. While both agents are active, outcomes remain somewhat modest and are balanced by toxicity. Amrubicin is an agent approved in some parts of the world, but randomized studies failed to demonstrate improvement over standard topotecan. Other cytotoxic agents have been studied that offer comparable efficacy, though data sets are limited. Immunotherapy, specifically nivolumab and pembrolizumab monotherapy, is an approved option as third-line monotherapy but the impact has been lessened with the integration of checkpoint inhibitors in the first-line setting. An understanding of which other agents have activity in this setting is increasingly relevant for the management of relapsed SCLC.