• Step-up dosing (T-cell engagers): Starting a bispecific T-cell engager (teclistamab, glofitamab, epcoritamab, tarlatamab) at a tiny dose and increasing it over the first week, so T cells are switched on gradually and the fever-and-low-blood-pressure reaction (cytokine release syndrome) stays mild.
• Limited-stage vs extensive-stage (small-cell lung cancer): Small-cell lung cancer uses a two-way split instead of the usual four stages: limited (confined to one side of the chest and treatable within one radiation field, about a third of patients) or extensive (everything else).
• Whole-brain radiotherapy (WBRT): Irradiating the entire brain, typically 30 Gy in 10 sessions, when metastases are too numerous or too widespread (leptomeningeal) for focused radiosurgery.
• Platinum-sensitive / platinum-resistant: Whether a cancer that responded to platinum chemotherapy came back more than six months later (sensitive, so platinum can be used again) or sooner (resistant, so something else is needed).
• Prophylactic cranial irradiation (PCI): Giving the brain a preventive dose of radiation (25 Gy in 10 sessions) before any metastasis can be seen, mainly in small-cell lung cancer, which spreads to the brain in over half of patients.
• Consolidation therapy: Treatment given after a good response to kill the cancer cells that are presumably left but cannot be seen, to make the remission last.
• ICANS (neurotoxicity): ICANS is confusion, speech difficulty, and rarely seizures after CAR-T or bispecific therapy.
• Maintenance therapy: Ongoing, gentler treatment given after the main course has shrunk the cancer, to hold it in check for as long as possible rather than to shrink it further.
• Cytokine release syndrome (CRS): A flood of inflammatory signals when immune cells are activated en masse, causing fever, low blood pressure, and sometimes organ failure.
• Brain metastases (intracranial disease): Tumour deposits that have travelled to the brain from a cancer elsewhere, ten times more common than cancers that start in the brain, mostly from lung, breast, melanoma and kidney cancer.

Biomarker results to ask for: Stage by PET-CT and brain MRI, Platinum-free interval at relapse (sensitive versus resistant), DLL3 expression (nearly universal; not required for tarlatamab), B7-H3 (ifinatamab deruxtecan trials), Transcription factor subtype and SLFN11 (research), PD-L1 and tumour mutational burden (not predictive in small-cell disease).

Scans and tests linked to this cancer: MRI, PET/CT, MRD / molecular residual disease testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

• First line: Four cycles of carboplatin or cisplatin plus etoposide with atezolizumab (IMpower133) or durvalumab (CASPIAN), then maintenance immunotherapy until progression; lurbinectedin added to atezolizumab maintenance (IMforte); serplulimab, adebrelimab or benmelstobart in China. (Platinum + etoposide (EP / CE), Carboplatin, Cisplatin, Etoposide, Atezolizumab, IMpower133, Durvalumab, CASPIAN, Lurbinectedin, IMforte, Serplulimab, ASTRUM-005, Adebrelimab, Benmelstobart, Maintenance therapy)
• Brain: MRI surveillance every three months or prophylactic cranial irradiation after response to first-line treatment; whole-brain or stereotactic radiotherapy for metastases. (Prophylactic cranial irradiation vs MRI surveillance, Prophylactic cranial irradiation (PCI), EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancer, Takahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancer, MRI, Whole-brain radiotherapy (WBRT), Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS))
• Thoracic consolidation: Consolidative thoracic radiotherapy (30 Gy in 10 fractions) for patients with residual chest disease after chemotherapy. (IMRT / IGRT (modern external beam), Hypofractionated radiotherapy, Consolidation therapy)
• Second line: Tarlatamab (DeLLphi-304) with inpatient monitoring for cytokine release syndrome during the first doses; lurbinectedin or topotecan as alternatives; platinum-etoposide rechallenge if relapse is more than six months after first line. (Tarlatamab, DeLLphi-304, T-cell engagers (bispecific), Cytokine release syndrome (CRS), ICANS (neurotoxicity), Step-up dosing (T-cell engagers), Lurbinectedin, Topotecan, Platinum + etoposide (EP / CE))

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.