Extensive-stage small-cell lung cancer: lines of therapy
4 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | 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. | NCCN Guidelines: Small Cell Lung Cancer | 95 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | 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. | NCCN Guidelines: Small Cell Lung Cancer | 94 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | 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 surveillanceProphylactic cranial irradiation (PCI)EORTC 08993 (Slotman): prophylactic cranial irradiation in extensive-stage small-cell lung cancerTakahashi trial: prophylactic cranial irradiation with MRI surveillance in extensive-stage small-cell lung cancerMRIWhole-brain radiotherapy (WBRT)Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS) | NCCN Guidelines: Small Cell Lung Cancer | 65 |
| All comers | Thoracic consolidation | Consolidative thoracic radiotherapy (30 Gy in 10 fractions) for patients with residual chest disease after chemotherapy. | NCCN Guidelines: Small Cell Lung Cancer | 93 |
Sequence and caution pairings
Chemo-immunotherapy followed by maintenance in small-cell lung cancer gives four cycles of chemotherapy plus immunotherapy, then keeps the immunotherapy going and adds a second drug to hold the disease longer.
Two new relapsed-disease options with different targets and mechanisms. Which comes first, and whether one works after the other, is unknown.
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.