Abstract
Simple SummaryExtended small cell lung cancer (ED-SCLC) remains an aggressive disease without major advances in the last 20 years. Recently, new therapies have eventually improved the outcomes of these patients, completely overturning their management. The objective of this review is to describe the most recent advances in ED-SCLC treatment, starting from immunotherapy as monotherapy or in combination with chemotherapy. Despite the proved clinical activity of this strategy, few patients achieve a long-term benefit and further studies are needed to find useful biomarkers. Furthermore, we review the most promising target agents and chemotherapies currently under investigation. Therefore, this proposal provides a comprehensive overview of available treatment strategies for ED-SCLC patients, highlighting their strengths and weaknesses.Extended small cell lung cancer (ED-SCLC) is a very aggressive disease, characterized by rapid growth and an early tendency to relapse. In contrast to non-small cell lung cancer, no therapeutic innovation has improved survival in patients with ED-SCLC over the past 20 years. Recently, immunotherapy has shown an important role in the management of these patients, emerging as the treatment of first choice in combination with chemotherapy and completely changing the therapeutic paradigm. However, patients’ selection for this strategy is still challenging due to a lack of reliable predictive biomarkers. Conversely, the immunotherapy efficacy beyond the first line is pretty disappointing and innovative chemotherapies or target agents seem to be more promising in this setting. Some of them are also under evaluation as an upfront strategy and they will probably change the treatment algorithm in the next future. This proposal provides a comprehensive overview of available treatment strategies for ED-SCLC patients, highlighting their strengths and weaknesses.
Highlights
Small cell lung cancer (SCLC) accounts for approximately 13% of lung cancer diagnoses [1].It is a very aggressive disease, characterized by rapid growth and an early tendency to metastasize.Extensive disease (ED-SCLC) accounts for more than 70% of new diagnoses with a 5-year survival of2.8% and a median overall survival (OS) of about 10 months [2]
The CASPIAN trial provided interesting results about another chemo-immunotherapy association [11]. This was a three-arm randomized, open-label, phase III trial with either standard platinum-based chemotherapy and etoposide, or the same chemotherapy combined with durvalumab 1500 mg every 3 weeks or durvalumab plus tremelimumab 75 mg every 3 weeks
CheckMate 032 was a non-comparative phase I/II study, which evaluated a monotherapy with nivolumab 3 mg/kg every 2 weeks versus the combination of nivolumab and ipilimumab for four cycles followed by nivolumab alone every 2 weeks at
Summary
Small cell lung cancer (SCLC) accounts for approximately 13% of lung cancer diagnoses [1]. It is a very aggressive disease, characterized by rapid growth and an early tendency to metastasize. Extensive disease (ED-SCLC) accounts for more than 70% of new diagnoses with a 5-year survival of. 2.8% and a median overall survival (OS) of about 10 months [2]. In contrast to non-small cell lung cancer, no therapeutic innovation has improved the survival in patients with ED-SCLC over the past 20 years [3].
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