The initial approach to SCLC treatment varies substantially by stage (1).
Small cell lung cancer is classified into limited stage (LS-SCLC; 30%) vs extensive stage (ES-SCLC; 70%) based on whether the disease can be treated within a radiation field that is typically confined to 1 hemithorax but may include contralateral mediastinal and supraclavicular nodes (2).
Management principles of SCLC
LS-SCLC
Patients with limited-stage SCLC are candidates for curative-intent radiation therapy and chemotherapy (2,3):
- for patients with LS-SCLC, surgery or concurrent chemotherapy with platinum-etoposide and radiotherapy is potentially curative in 30% of patients (2)
- median survival for LS-SCLC has reached up to 55.9 months with the addition of durvalumab, an immunotherapy
ES-SCLC
The mainstay of therapy for patients with the extensive stage is systemic chemotherapy (2,3):
- first-line treatment for ES-SCLC is combined treatment with platinum-etoposide chemotherapy and immunotherapy with the programmed cell death 1 ligand 1 (PD-L1) inhibitors durvalumab or atezolizumab followed by maintenance immunotherapy until disease progression or toxicity (2)
- initial rates of tumor shrinkage are 60% to 70% with platinum-etoposide and immunotherapy treatment, the median overall survival of patients treated for ES-SCLC is approximately 12 to 13 months, with 60% of patients relapsing within 3 months
- second-line therapy for patients with ES-SCLC includes (2)
- DNA-alkylating agent lurbinectedin (35% overall response rate; median progression-free survival, 3.7 months) and
- a bispecific T-cell engager against delta-like ligand 3, tarlatamab (40% overall response rate; median progression-free survival, 4.9 months)
Reference:
- Rudin CM, Brambilla E, Faivre-Finn C, Sage J. Small-cell lung cancer. Nat Rev Dis Primers. 2021 Jan 14;7(1):3.
- Kim SY, Park HS, Chiang AC. Small Cell Lung Cancer: A Review. JAMA. 2025;333(21):1906–1917.
- Basumallik N, Agarwal M. Small Cell Lung Cancer. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.