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This algorithm covers systemic therapy for small cell lung cancer, divided first by stage and then by setting at relapse. For extensive-stage disease, the standard first-line approach is chemotherapy plus atezolizumab followed by lurbinectedin plus atezolizumab maintenance (IMpower133 / IMforte), with chemotherapy plus durvalumab as an alternative (CASPIAN), which improved overall survival versus chemotherapy alone. For limited-stage disease, definitive cisplatin and etoposide with radiotherapy is followed by consolidation durvalumab (ADRIATIC).
At relapse, performance status determines the branch. Patients with performance status 0 to 2 can receive tarlatamab, a DLL3-directed bispecific T-cell engager (DeLLphi-301) and the first approved in this disease; lurbinectedin if not previously given (PM1183); or oral or IV topotecan as the cytotoxic option. Patients with performance status 3 to 4 are managed with best supportive care, with or without palliative radiotherapy for symptoms.
Background reading: Small cell lung cancer (SCLC) board review notes.
Starting point: Small cell lung cancer by stage → systemic Rx. Full background: Small cell lung cancer (SCLC) notes.