Managing Patients With Relapsed Small-Cell Lung Cancer

Abstract

Despite high response rates to initial therapy, relapses are common in patients with small-cell lung cancer (SCLC). Systemic therapy after first-line failure remains important in the treatment paradigm of SCLC. Reinitiation of a previously administered first-line chemotherapy regimen is recommended for relapse > 6 months from completion of initial therapy. For relapse ≤ 6 months of initial therapy, sequential therapy with single agents is recommended. Clinical trial enrollment should be considered at all stages of treatment of SCLC. This review highlights the available treatment options in relapsed SCLC. In particular, we focus on prospective clinical trials demonstrating activity for the most commonly used agents in this setting. We end with a discussion on future directions and emerging targets with potential to improve outcomes in relapsed SCLC.

Fig 1.

Treatment algorithm for relapsed small-cell lung cancer (SCLC). CAV, cyclophosphamide, doxorubicin, and vincristine; CIE, cisplatin, irinotecan, and etoposide; TFI, treatment-free interval after initial therapy. (*)Enrollment into clinical trials should be considered at all stages of treatment of SCLC. (†)For programmed cell death ligand-1 expression ≥ 1%. (‡)For second-line treatment of sensitive relapsed SCLC (TFI ≥ 90 days).