Small-Cell Lung Cancer Updates

Abstract

Small-cell lung cancer (SCLC) is a high-grade, aggressive neuroendocrine tumor with a particularly poor prognosis, characterized by early metastases and rapid development of therapy resistance. There have historically been few treatment options for advanced or extensive stage SCLC, which comprises 70% of patients at the time of diagnosis, and 5-year survival rates for these patients have been under 5% for decades. Treatment of SCLC is now undergoing rapid changes due to advances in the field and many promising clinical trials, with several new therapy approvals within the last year. Advanced SCLC treatment is now a combination of chemotherapy and immunotherapy in the first line, with multiple second and later-line options. Early-stage SCLC is treated with chemoradiation followed by consolidative immunotherapy, a change in practice based on a recent clinical trial demonstrating an improvement of almost 2 years in median overall survival. In the era of immunotherapy and novel agents, prognosis has improved for advanced-stage disease, with 3-year survival rates of 16 and 17% in clinical trials for chemoimmunotherapy combinations. Despite these advances, most patients will progress within 6 months of starting first-line chemoimmunotherapy; thus, this disease continues to represent an area of unmet need. This update will highlight current standard of care practices and updates of recent promising trials that have improved outcomes, including survival, for SCLC patients.