OnCo

Small-cell lung cancer: lines of therapy

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11 standard-of-care settings across 6 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comersEGFR
Screening, prevention and diagnosis1·
Locally advanced3·
Advanced, first line2·
Second line3·
Special situations1·
Other settings·1

Screening, prevention and diagnosis

SubgroupSettingApproachProducts and trialsEvidence
All comersScreening and diagnosisLow-dose CT screening in heavy smokers finds some SCLC but stage shift is limited; diagnosis by bronchoscopic or CT-guided biopsy; staging with PET/CT and brain MRI.68

Locally advanced

SubgroupSettingApproachProducts and trialsEvidence
All comersLimited stageChemoradiationdurvalumab; prophylactic cranial irradiation or MRI surveillance.91
All comersVery limited stage (T1-2 N0, ~5%)Lobectomy with mediastinal node dissection or SBRT, followed by adjuvant platinum-etoposide; PCI or MRI surveillance.82
All comersLimited stageConcurrent cisplatin-etoposide with thoracic radiotherapy (45 Gy twice daily or 60-70 Gy once daily), then durvalumab consolidation up to 2 years (ADRIATIC); PCI or MRI surveillance.91

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersExtensive stagePlatinum-etoposide + atezolizumab/durvalumab; lurbinectedin + atezolizumab maintenance.86
All comersExtensive stage, first lineCarboplatin-etoposide plus atezolizumab or durvalumab (4 cycles), then maintenance immunotherapy; lurbinectedin added to atezolizumab maintenance since 2025 (IMforte). Serplulimab-chemotherapy where approved. Consolidative thoracic radiotherapy for residual thoracic disease in good responders.95

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersRelapsedTarlatamab (preferred), lurbinectedin, topotecan; I-DXd in trials.94
All comersRelapsed, platinum-sensitive (≥90 days)Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan.94
All comersRelapsed, platinum-resistant (<90 days)Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics).85

Special situations

SubgroupSettingApproachProducts and trialsEvidence
All comersBrain metastasesWhole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised.40

Other settings

SubgroupSettingApproachProducts and trialsEvidence
EGFRTransformed SCLC (from EGFR-mutant NSCLC)Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials.87

Sequence and caution pairings

Regimens in the library

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.