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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Small-cell lung cancer that has spread responds fast to chemotherapy but almost always returns within a year. Adding an immunotherapy antibody to first-line chemotherapy helps a minority live for years, and the T-cell engager tarlatamab, which points immune cells at the DLL3 protein on the cancer, has for the first time lengthened life after relapse.
Extensive-stage small-cell lung cancer has been treated with platinum plus etoposide since the 1980s, with response rates of 60 to 70 percent but relapse within months, and thirty years of trials of added drugs, maintenance and dose intensity failed. IMpower133 (2018) was the first success: adding atezolizumab to carboplatin-etoposide lengthened median overall survival from 10.3 to 12.3 months (hazard ratio 0.70), and CASPIAN (2019) did the same with durvalumab (13.0 versus 10.3 months, hazard ratio 0.73); both were approved in 2019 and 2020 and a long tail of about 15 percent of patients alive at three years appeared. Chinese trials followed with serplulimab (ASTRUM-005, 15.4 versus 10.9 months, hazard ratio 0.63), adebrelimab and benmelstobart. IMforte (2025) then showed that adding lurbinectedin to atezolizumab maintenance after induction extended survival from 10.6 to 13.2 months (hazard ratio 0.73), approved in October 2025.
Second-line treatment was topotecan, with response rates around 20 percent, until lurbinectedin received accelerated approval in 2020 on a 35 percent response rate. Tarlatamab, a bispecific T-cell engager that binds DLL3 on small-cell cells and CD3 on T cells, produced a 40 percent response rate in DeLLphi-301 (2023) with cytokine release syndrome in about half, mostly mild, and received accelerated approval in May 2024; DeLLphi-304 (2025) then showed it lengthened median overall survival to 13.6 months against 8.3 months with chemotherapy (hazard ratio 0.60), the first randomised survival gain after relapse in this disease, and it is now the standard second-line treatment. The B7-H3 antibody-drug conjugate ifinatamab deruxtecan (IDeate-Lung02) and further DLL3 engagers are in phase 3.
| Setting | Approach | Guideline |
|---|---|---|
| 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. | not mapped |
| 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. | not mapped |
| Brain | MRI surveillance every three months or prophylactic cranial irradiation after response to first-line treatment; whole-brain or stereotactic radiotherapy for metastases. | not mapped |
| Thoracic consolidation | Consolidative thoracic radiotherapy (30 Gy in 10 fractions) for patients with residual chest disease after chemotherapy. | not mapped |