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Update 2021: Management of Small Cell Lung Cancer

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Abstract

Background

Accounting for 14% of lung cancer, small cell lung cancer (SCLC) is a highly aggressive neuroendocrine malignancy with rapid proliferation, early spread, and poor survival.

Aim and Methods

We provide an overview of recent advances regarding SCLC pathogenesis, subtypes, and treatment development through literature review of key trials.

Results

There are no validated biomarkers or approved targeted treatments for this overly heterogeneous disease, but recent analyses have identified some promising targets and four major subtypes which may carry unique therapeutic vulnerabilities in SCLC. Treatment wise, only a third of patients present with limited stage SCLC, which can be managed with a combined modality approach with curative intent (usually chemo-radiotherapy, but in some eligible patients, surgery followed by systemic treatment). For advanced or extensive stage SCLC, combined chemotherapy (platinum–etoposide) and immunotherapy (atezolizumab or durvalumab during and after chemotherapy) has become the new standard front-line treatment, with modest improvement in overall survival. In the second-line setting, for disease relapse ≤ 6 months, topotecan, lurbinectedin, and clinical trials are reasonable treatment options; for disease relapse > 6 months, original regimen, topotecan or lurbinectedin can be considered. Moreover, Trilaciclib, a CD4/CD6 inhibitor, was recently FDA-approved to decrease the incidence of chemotherapy-related myelosuppression in SCLC patients.

Conclusions

While modest improvements in survival have been made especially in the metastatic setting with chemo-immunotherapy, further research in understanding the biology of SCLC is warranted to develop biomarker-driven therapeutic strategies and combinational approaches for this aggressive disease.

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  1. Sara Tariq and So Yeon Kim are co-first-authors.

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  1. Department of Medical Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Sara Tariq, So Yeon Kim & Haiying Cheng

  2. Montefiore Medical Center, Bronx, NY, 10461, USA

    Jose Monteiro de Oliveira Novaes

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  1. Sara Tariq
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Correspondence to Haiying Cheng.

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Tariq, S., Kim, S.Y., Monteiro de Oliveira Novaes, J. et al. Update 2021: Management of Small Cell Lung Cancer. Lung 199, 579–587 (2021). https://doi.org/10.1007/s00408-021-00486-y

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