New Treatments for Small Cell Lung Cancer: A 2026 Map of Options and Access
In this article
The treatment map for small cell lung cancer: line by line, layer by layer
For small cell lung cancer, 2026 was the busiest year in three decades. For the first time, a maintenance treatment entered the first line; new agents showing superiority over chemotherapy in the second line announced phase 3 results one after another; and substantial response rates began to be discussed for the third line and beyond for the first time. An option was also lost that year: lurbinectedin's second-line indication is being withdrawn.
This article was written to organize that activity. We address each treatment line separately and divide the options at every line into three layers : those approved today, those awaiting approval, and those still at an early stage and available only through a clinical study. The aim is for a patient or physician to find an answer to the question, "I am at this point now; what is available for me?" on a single page.
LAYER 1 — APPROVED. Approved at this treatment line by at least one major regulatory authority. Can be prescribed; access depends on the country and reimbursement.
LAYER 2 — ON THE PATH TO APPROVAL. Positive phase 3 results, with a regulatory submission made or a decision awaited. Cannot be prescribed today; the situation may change within months.
LAYER 3 — EARLY. Phase 1 or phase 2 data available, with phase 3 absent or ongoing. Access only through a clinical study or expanded access program.
Some cells in the tables below are empty, marked with — . This is a deliberate choice: if an agent has response-rate data but no progression-free survival data, showing it at the correct treatment line with whatever information is available is more useful than omitting it entirely. An empty cell means "no data yet," not "poor data."
The second caution is more important: the agents in these tables have not been tested against one another. They were studied in different countries, years, patient populations, and against different comparators. To see this concretely, look at the control arms: in the same disease, at the same treatment line, the same drug (topotecan) produced survival of 9,4 months in one study and 10,3 months in another. Thus, placing bars side by side and saying "the longest is best" is wrong. The tables aim to put options in the right place rather than rank them.
The entire map on one page
| Treatment line | Layer 1 — Approved | Layer 2 — On the path to approval | Layer 3 — Early |
|---|---|---|---|
| Limited-stage after chemoradiotherapy |
Durvalumab consolidation | — | Tarlatamab consolidation (DeLLphi-306, no results) |
| Extensive-stage line 1. |
Atezolizumab + chemotherapy Durvalumab + chemotherapy China: serplulimab, adebrelimab, benmelstobart+anlotinib |
— | Pumitamig + chemotherapy Iza-bren + serplulimab Pumitamig + elfetabart drozuntecan |
| Line 1. maintenance |
Lurbinectedin + atezolizumab | Tarlatamab + durvalumab (DeLLphi-305 positive, no figures) |
— |
| Line 2. | Tarlatamab Topotecan Platinum rechallenge Japan: amrubicin |
Ifinatamab deruxtecan (FDA 10 October) Risvutatug rezetecan (China) Tambotatug pelitecan (China) |
ZL-1310 · Iza-bren · Sacituzumab govitecan · Pumitamig + paclitaxel · Gocatamig |
| Line 3. and beyond |
None — no approved option other than chemotherapy | — | Pumitamig + elfetabart drozuntecan · Ifinatamab deruxtecan access program · ZL-1310 · Gocatamig · Obrixtamig · Peluntamig |
| Withdrawn | Lurbinectedin monotherapy, line 2. — LAGOON phase 3 failed; indication being withdrawn | ||
There is no approved new agent for the third line and beyond. Once tarlatamab and chemotherapy have also been used, the only remaining options are more chemotherapy or a clinical study. The most work-intensive section of this article fills Layer 3 in that row — because things are really happening there, and this is information a patient cannot find unaided.
Limited-stage: after chemoradiotherapy
Layer 1 — Approved Durvalumab consolidation
Durvalumab
PD-L1 inhibitor · Consolidation after concurrent chemoradiotherapy
| ADRIATIC, phase 3 | Durvalumab | Placebo | Comparison |
|---|---|---|---|
| Number of patients | 730 (three arms) | ||
| Median overall survival | 55,9 months | 33,4 months | HR 0,73 (0,57-0,93); p=0,0104 |
| Median progression-free survival | 16,6 months | 9,2 months | HR 0,76 (0,61-0,95); p=0,0161 |
| Approval | FDA: 4 December 2024 | ||
This is the largest advance in limited-stage disease in more than two decades: in patients without progression after chemoradiotherapy, median survival rose from 33,4 months to 55,9 months — almost two years. Limited-stage disease is the only form of small cell lung cancer with a chance of cure , making the gain achieved here particularly valuable.
Layer 3 — Early Tarlatamab consolidation
Tarlatamab (DeLLphi-306)
DLL3-targeted bispecific T-cell engager · Consolidation after chemoradiotherapy · Phase 3
The study is ongoing. No results have been announced as of 15 September 2026 — only trial-in-progress presentations have been published. It is worth following as an attempt to bring tarlatamab into early-stage disease.
Extensive-stage, first-line
Layer 1 — Approved Chemoimmunotherapy: today's standard
Since 2019, the first line has been based on adding a PD-L1 inhibitor to platinum + etoposide chemotherapy . Two options are approved in the West, with three additional options in China.
| Regimen | Study · N | Median overall survival | Hazard ratio | Median PFS | Approval |
|---|---|---|---|---|---|
| Atezolizumab + carboplatin/etoposide | IMpower133 N=403 |
12,3 vs 10,3 months | 0,70 (0,54-0,91) | 5,2 vs 4,3 months | FDA 2019 · global |
| Durvalumab + platinum/etoposide | CASPIAN N=805 |
13,0 vs 10,3 months | 0,73 (0,59-0,91) | 5,1 vs 5,4 months | FDA 2020 · global |
| Serplulimab + carboplatin/etoposide | ASTRUM-005 N=585 |
15,4 vs 10,9 months | 0,63 (0,49-0,82) | 5,7 vs 4,3 months | China 2023 · EU 4 February 2025 |
| Adebrelimab + carboplatin/etoposide | CAPSTONE-1 N=462 |
15,3 vs 12,8 months | 0,72 (0,58-0,90) | 5,8 vs 5,6 months | China 2023 |
| Benmelstobart + anlotinib + etoposide/carboplatin | ETER701 N=738 (three arms) |
19,3 vs 11,9 months | 0,61 (0,47-0,79) | 6,9 vs 4,2 months HR 0,32 |
China |
Two points to watch when reading this table: First, the figures in Chinese studies appear markedly higher than in Western studies — but look at the control arms: 10,3 · 10,3 · 10,9 · 12,8 · 11,9 months. The control arms differ too, meaning the populations differ. Second, ETER701's 19,3-month survival is striking, but it comes at a cost: the severe adverse event rate is %93,1 (%87,0 in the control arm). Adding anlotinib increases efficacy while also markedly raising toxicity.
Layer 1 — Approved Maintenance treatment: the new category of 2025
Lurbinectedin + atezolizumab
Alkylating agent + PD-L1 inhibitor · Post-induction maintenance · IMforte phase 3
| IMforte | Lurbinectedin + atezolizumab (n=242) | Atezolizumab (n=241) | Comparison |
|---|---|---|---|
| Design | 660 patients received induction (atezolizumab + carboplatin + etoposide, 4 cycles) → 483 patients without progression randomized | ||
| Median PFS | 5,4 months (4,2-5,8) | 2,1 months (1,6-2,7) | HR 0,54 (0,43-0,67); p<0,0001 |
| Median overall survival | 13,2 months (11,9-16,4) | 10,6 months (9,5-12,2) | HR 0,73 (0,57-0,95); p=0,0174 |
| Response rate | %19,4 | %10,4 | — |
| Adverse events of grade ≥3.-4. | %38 | %22 | — |
| Approval | FDA 2 October 2025 · Europe 29 May 2026 | ||
In extensive-stage small cell lung cancer, this is the first approved maintenance treatment. Until now, waiting was the only thing to do after induction ended; there is now an option that delays disease return. The gain is modest but real: disease-free time rises from 2,1 months to 5,4 months, and survival from 10,6 months to 13,2 months.
This category is easily overlooked — if "we are no longer doing anything" is said as induction ends, it never comes up. This is a question to ask when first-line treatment ends.
Layer 2 — On the path to approval Tarlatamab + durvalumab maintenance
Tarlatamab + durvalumab (DeLLphi-305)
DLL3 bispecific T-cell engager + PD-L1 inhibitor · Post-induction maintenance · Phase 3
| Indicator | Status |
|---|---|
| Number of patients | 563, randomized 1:1 |
| Primary endpoint (overall survival) | Met — "statistically significant and clinically meaningful" |
| PFS and response rate | Both significant |
| Median survival · hazard ratio · median PFS | — not disclosed |
| Announcement | 8 September 2026, manufacturer press release. Not presented at a congress. |
The preceding phase 1b study (DeLLphi-303, N=88) offers some insight: median overall survival 25,3 months, median PFS 5,6 months, cytokine release syndrome %56 (mostly mild), ICANS %6.
An announcement of "positive results" does not say how positive. The hazard ratio could be 0,90 or 0,60; both may be "statistically significant," but their clinical meanings differ greatly. The actual figures must be published before this agent can be assessed in maintenance treatment.
Layer 3 — Early Combinations under investigation in the first line
Pumitamig + chemotherapy
PD-L1 × VEGF-A bispecific antibody · Phase 2 · Two separate studies
| Study | N | Response rate | Median PFS | Overall survival | Grade ≥3. |
|---|---|---|---|---|---|
| Phase 2, China | 50 | %85,4 DCR %97,9 |
6,9 months | At 12 months, %72,7 median — |
%86 |
| Phase 2, global | 43 | %76,3 DCR %100 |
6,8 months | — | — |
Response rates are very high, but the severe adverse event rate is also %86 — immunotherapy and antiangiogenic treatment side effects add to those of chemotherapy. The phase 3 study ROSETTA Lung-01 (approximately 576 patients, versus atezolizumab) is ongoing and also includes Türkiye.
Izalontamab brengitecan (iza-bren) + serplulimab
EGFR × HER3 bispecific antibody-drug conjugate + PD-1 inhibitor · Phase 2 · ELCC 2026
| Indicator | Result |
|---|---|
| Number of patients | 82 enrolled / 77 in efficacy analysis |
| Response rate | %88,3 (confirmed %77,9) · disease control %94,8 |
| Median duration of response | 7,3 months |
| Median PFS | 8,2 months (6,7-9,6) |
| Overall survival | At 12 months, %80,8 · median — |
| Lung inflammation (ILD) | %2,4 (1 mild, 1 moderate) |
| Discontinuation rate | %7,3 |
Median PFS of 8,2 months is above today's first-line standards (5,1-6,9 months). However, this is a single-arm phase 2 study, and the agent has no phase 3 study in small cell disease.
Pumitamig + elfetabart drozuntecan
PD-L1 × VEGF bispecific + B7-H3-targeted ADC · Phase 1b/2 · WCLC 2026
Response rate in the first-line subgroup %92,3 — data for all treatment lines from this study are discussed in detail below, in the third-line section, because that is where its main value lies.
Small cell lung cancer almost always responds well to initial treatment — even chemotherapy alone produces a %60-70 response rate. The problem is not obtaining a response, but its short duration. Thus, although first-line response rates such as %85-92 look impressive, the real question is: how long does this response last, and does it translate into survival?
Median overall survival has not yet matured for any of the three combinations above. The approved standards can be assessed because those figures matured years ago.
Second-line: progression after platinum
Progression after first-line treatment is a turning point experienced by almost all patients with small cell lung cancer. This treatment line had remained unchanged for three decades until 2024; now there is both an approved new agent and three agents awaiting approval.
Layer 1 — Approved Tarlatamab: the global standard
Tarlatamab
DLL3-targeted bispecific T-cell engager · DeLLphi-304 phase 3
| DeLLphi-304, N=509 | Tarlatamab (n=254) | Chemotherapy (n=255) | Comparison |
|---|---|---|---|
| Median overall survival | 13,6 months | 8,3 months | HR 0,60 (0,47-0,77); p<0,001 |
| 12-month survival | %53 | %37 | — |
| Median PFS | 4,2 months | 3,7 months | HR 0,71 (0,59-0,86) |
| 12-month PFS | %20 | %4 | Fivefold |
| Response rate | %35 | %20 | — |
| Median duration of response | 6,9 months | 5,5 months | — |
| Adverse events of grade ≥3. | %27 | %62 | In favor of tarlatamab |
| Discontinuation rate | %3 | %6 | — |
| Approval | FDA full approval 19 November 2025 · Japan 27.12.2024 · China 10.04.2026 · Europe 29.05.2026 | ||
The median PFS difference is only half a month. But the proportion of patients still without progression after one year is %20 versus %4 — fivefold. Tarlatamab benefits not "everyone a little," but a minority greatly . This is typical of T-cell engagers and is the most important nuance when talking with patients: if it works, it can last a long time.
Administration is changing. Tarlatamab's greatest practical problem is not efficacy, but the requirement after the first two doses for 48 hours of observation . Two studies aimed at easing this were presented at WCLC 2026:
| Study | What was tested | Response rate | PFS | Cytokine release syndrome |
|---|---|---|---|---|
| DeLLphi-309 phase 2, n=252 |
10 mg every 2 weeks 20 mg every 3 weeks 30 mg every 4 weeks |
%40 %31 %27 |
4,2 months 4,1 months 2,7 months |
%60-70, mostly mild ICANS %6-12 |
| DeLLphi-308 phase 1b, n=60 |
Subcutaneous 15 mg, every 2 weeks | %30 | 3,7 months OS 11,7 months |
%38 — all mild Discontinuation %2 |
Convenience comes at a cost in both: response rates fall as dosing intervals lengthen (%40 → %27), and are also lower with the subcutaneous formulation than intravenous administration (%30 versus %40 in phase 2). The subcutaneous formulation's phase 3 study (DeLLphi-315) will compare it with intravenous administration.
Layer 1 — Approved Older but still valid options
Platinum regimen rechallenge
In platinum-sensitive relapse (progression ≥90 days after the last platinum dose) · Phase 3, N=162
| Carboplatin + etoposide | Topotecan | Comparison | |
|---|---|---|---|
| Response rate | %49 | %25 | p=0,0024 — twofold |
| Median PFS | 4,7 months | 2,7 months | HR 0,57; p=0,0041 |
| Median overall survival | 7,5 months | 7,4 months | HR 1,03 — no difference |
The tension in this table matters: platinum rechallenge doubles the response rate and nearly doubles disease-free time — but does not prolong survival. It therefore makes the disease regress without changing the outcome. This is one of the clearest examples of the difference between shrinking a tumor and helping a patient live longer, and also explains why tarlatamab matters: tarlatamab is the first agent to prolong survival .
Topotecan · amrubicin
Conventional chemotherapy options
Topotecan is approved globally, generic, and inexpensive (approximately 32 dollars per vial in the United States). It was in DeLLphi-304's control arm: median survival 8,3 months. Amrubicin is approved only in Japan and is a standard option for recurrent disease there; it is not approved in the United States or Europe.
The lost option Lurbinectedin monotherapy is being withdrawn
In 2020, lurbinectedin received accelerated approval based on a single-arm phase 2 study of 105 patients with a %35,2 response rate . Accelerated approval is conditional; a confirmatory study is mandatory. That study was LAGOON — 724 patients, more than 200 centers, three arms.
| LAGOON, N=724 | Median overall survival | Versus control |
|---|---|---|
| Lurbinectedin single agent | 8,7 months | HR 1,190 (0,959-1,476) — numerically worse |
| Lurbinectedin + irinotecan | 10,9 months | HR 0,902 (0,729-1,115) — not significant |
| Investigator's choice (topotecan/irinotecan) | 10,7 months | — |
No comparison reached significance, and the manufacturer announced that the second-line indication would be withdrawn. The first-line maintenance approval is unaffected.
Accelerated approval is a promise, not a guarantee. A drug being "FDA-approved" does not always mean that superior survival has been demonstrated. The question to ask when a drug is recommended is: what evidence supports this approval — response rate or survival?
For a patient currently taking lurbinectedin and benefiting, the decision belongs to the treatment team; withdrawal of the indication does not mean "this drug is harming you," but "superiority over chemotherapy was not demonstrated at the group level."
Layer 2 — On the path to approval Three agents, three separate doors
Ifinatamab deruxtecan
B7-H3-targeted ADC · IDeate-Lung01 phase 2, n=137 (12 mg/kg) · FDA decision 10 October 2026
| Indicator | Result |
|---|---|
| Response rate | %48,2 · in the second-line subgroup %56,3 |
| Disease control rate | %87,6 |
| Median duration of response | 5,3 months |
| Median PFS | 4,9 months |
| Median overall survival | 10,3 months |
| Intracranial response | approximately %46 |
| Lung inflammation (ILD) | %12,4 — grade 3. %2,9, fatal %1,5 |
| Treatment-related death | %4,4 |
Under priority review; because of Project Orbis, a favorable decision could bring simultaneous approvals in several countries. The confirmatory phase 3 study (IDeate-Lung02) is ongoing, with no results. Access today is only through an expanded access program — details below.
Risvutatug rezetecan (HS-20093)
B7-H3-targeted ADC · ARTEMIS-008 phase 3 · WCLC 2026, 14 September · Chinese submission accepted, 2 September 2026
| ARTEMIS-008, N=461 | Risvutatug rezetecan (n=230) | Topotecan (n=231) | Comparison |
|---|---|---|---|
| Median overall survival | 18,5 months | 10,3 months | HR 0,46; p<0,0001 |
| Median PFS | Consistent benefit in both assessments | figures — | |
| Response rate | In favor of risvutatug rezetecan | figures — | |
| Adverse events of grade ≥3. | %60,9 | %78,2 | — |
| Lung inflammation | %11,7 (no grade 4.-5.) | %1,9 | — |
| Thrombocytopenia | %13,9 | %59,7 | Marked advantage |
| Intracranial activity | Consistent benefit in the brain metastasis subgroup — separate response rate — | ||
18,5 months is the highest median survival reported to date in recurrent small cell lung cancer. However, this is an interim analysis , and the study was conducted entirely in China.
Tambotatug pelitecan (YL201)
B7-H3-targeted ADC · TAISHAN-302 phase 3 · WCLC 2026 · Chinese submission accepted
| TAISHAN-302, N=451 | Tambotatug pelitecan (n=225) | Topotecan (n=226) | Comparison |
|---|---|---|---|
| Median overall survival | 13,3 months | 9,4 months | HR 0,46; p<0,0001 |
| Median PFS | 7,4 months | 2,8 months | HR 0,29 |
| Response rate | %59,1 | %9,7 | DCR %91,1 vs %50,9 |
| Adverse events of grade ≥3. | %46,4 | %74,7 | — |
| Lung inflammation | %4,9 (no grade 4.-5.) | %1,4 | — |
| Treatment-related death | 0 | — | — |
| Intracranial response | %32,4 | %2,9 | Intracranial PFS 6,1 vs 4,2 months |
- Both were conducted entirely in China. There are no phase 3 data in Western populations; a global phase 3 study is planned but has not started.
- The comparator was topotecan, not tarlatamab. They were therefore tested against a three-decade-old standard rather than today's global standard. This is an understandable design because tarlatamab was approved in China only in April 2026 — but it is decisive when interpreting the result.
- The data are immature. ARTEMIS-008 is an interim analysis; in TAISHAN-302, follow-up is shorter than median survival in the experimental arm.
- Neither is approved in any country. "Submission accepted" means accepted for review, not approved.
Layer 3 — Early Investigational options in the second line
| Agent | Target / type · Phase · N | Response rate | PFS | Overall survival | Toxicity note |
|---|---|---|---|---|---|
| ZL-1310 | DLL3 ADC · Phase 1 · n=19 (line 2., 1,6 mg/kg) | %68 | 5,4 months (entire cohort) | — | Grade ≥3. %13 · discontinuation %0 · ILD only 2 mild cases |
| Iza-bren izalontamab brengitecan |
EGFR × HER3 bispecific ADC · Phase 1b · n=22 (line 2. subgroup) | %72,7 DCR %90,9 |
6,2 months | 15,0 months | Grade ≥3. %75 · discontinuation %13 · ILD %0 |
| Pumitamig + paclitaxel | PD-L1 × VEGF bispecific + chemotherapy · Phase 2 · n=70 | %41,5 DCR %87,7 |
5,5 months | 14,3 months | Grade ≥3. %78,6 · 2 treatment-related deaths (%2,9) |
| Sacituzumab govitecan | TROP-2 ADC · Phase 2 · n=43 | %41,9 platinum-sensitive %47,8 / resistant %35,0 |
4,4 months | 13,6 months sensitive 14,7 / resistant 6,6 |
Grade ≥3. %74,4 · neutropenia %44 · discontinuation %0 |
| Gocatamig MK-6070 |
DLL3 T-cell engager · Phase 1/2 · n=73 (39 with small cell disease) | %44 %55 at 24 mg doses |
— | — | CRS %55 · ICANS %7 (all mild) · grade ≥3. %29 |
The difference in response rates is moderate (%47,8 versus %35), but the survival difference is more than twofold: 14,7 months in platinum-sensitive patients and 6,6 months in platinum-resistant patients. The same drug, study, and dose — only the disease's biological aggressiveness changes.
Practical meaning: Expectations for a new agent are determined by more than the drug itself. Disease progressing within six months of platinum treatment has a worse course, whatever drug is given. This distinction was not reported separately in most other studies in this article.
Third-line and beyond: the emptiest but busiest part of the map
Layer 1 — Approved None
Once tarlatamab and chemotherapy have also been used, no agent is approved for this treatment line in small cell lung cancer. There is none under any regulatory authority worldwide.
What remains is a chemotherapy not previously used (topotecan, irinotecan, a taxane) — and the expected response rates at this line are low and responses brief. At this line, therefore, a clinical study is the most reasonable first option, rather than a "last resort."
Layer 2 — On the path to approval None
No agent at this treatment line has a regulatory submission or announced phase 3 result. Ifinatamab deruxtecan's FDA submission covers patients with "progression after platinum"; if the decision is positive, heavily pretreated patients may also fall within this scope, but the indication wording does not specifically define the third line.
Layer 3 — Early This is where the real activity is
Pumitamig + elfetabart drozuntecan — the most striking data at this line
Elfetabart drozuntecan (Elfe-D; previous codes DB-1311 / BNT324): a B7-H3-targeted antibody-drug conjugate — it hits the same target as ifinatamab deruxtecan and the two Chinese ADCs. The developers are DualityBio and BioNTech.
Pumitamig (BNT327 / PM8002 / BMS-986545): a bispecific antibody binding PD-L1 and VEGF-A simultaneously — immunotherapy and antiangiogenic treatment in a single molecule. A BioNTech and Bristol Myers Squibb partnership, under a June 2025 agreement with 1,5 billion dollars upfront and a total potential value of up to 11,1 billion dollars.
Reading the drug from its name: In the new international naming system, the suffix -bart indicates an engineered antibody, -mig indicates a bispecific antibody, and -tecan indicates that the payload is a topoisomerase-1 inhibitor.
- Phase 1b/2, single-arm, no comparator. Response rate and survival are not the same thing.
- Duration of response, PFS, and overall survival have not been disclosed. A %70 response rate means very little if responses are brief. No judgment can be made before these three figures arrive.
- Subgroup numbers are small. The statement "third-line and beyond %52,4" refers to a subset of 71 patients.
- There is a critical safety gap: For this combination, the rate of lung inflammation (ILD) has not been reported in any source. Elfe-D is an ADC carrying a topoisomerase-1 inhibitor, and this class has a known lung risk — for ifinatamab deruxtecan, the rate is %12,4, with %1,5 fatal.
- It is not approved in any country and has no phase 3 study in small cell disease . Elfe-D's FDA statuses apply to prostate cancer (fast track) and esophageal cancer (orphan drug).
A source caution: Some news sources described the same study as "pumitamig + ifinatamab deruxtecan." Because both drugs are B7-H3 ADCs, confusion is likely; the developer's release and three independent sources say elfetabart drozuntecan .
Other early agents
| Agent | Target / type · Phase | Data in heavily pretreated patients | PFS / OS | Toxicity | Access |
|---|---|---|---|---|---|
| Ifinatamab deruxtecan | B7-H3 ADC · Phase 2 | Response %48,2 (≥1 prior line, n=137) | PFS 4,9 months OS 10,3 months |
ILD %12,4, fatal %1,5 | Expanded access program open — criteria below |
| ZL-1310 | DLL3 ADC · Phase 1 | Responses in 3 of 7 patients after tarlatamab Active in a cohort where %44 had failed two treatment lines |
PFS 5,4 months OS — |
Grade ≥3. %13 · discontinuation %0 | Phase 3 (approximately 665 patients) explicitly accepts patients after tarlatamab |
| Iza-bren | EGFR × HER3 bispecific ADC · Phase 1b | Response in the entire cohort %48,1 (n=52, all after platinum) | PFS 4,1 months OS 12,2 months DoR 4,9 months |
Grade ≥3. %75 · ILD %0 · discontinuation %13 | No phase 3 in small cell disease |
| Gocatamig | DLL3 T-cell engager · Phase 1/2 | Response %44; at 24 mg doses, %55 (n=73, %95 previously received platinum) | — | CRS %55 · ICANS %7 · grade ≥3. %29 | With ifinatamab deruxtecan, a combination study has begun |
| Obrixtamig | DLL3 × CD3 T-cell engager · Phase 1 | Response %18 overall, in small cell disease %17 (n=154, 65 with small cell disease) | DoR 8,5 months PFS 1,5 months |
CRS %57 · grade ≥3. %24 · 2 treatment-related deaths | Phase 1 |
| Peluntamig | DLL3 × CD47 · Phase 1/2 | — no efficacy data | — | — | Only a trial-in-progress presentation published |
Why the obrixtamig row matters: At %17-18, the response rate is the lowest in this table — but median duration of response is 8,5 months, the longest in the table. This illustrates why the assumption that "a higher response rate is always better" is flawed: a lasting response in a few patients may be more valuable than a two-month response in many. It is also striking that agents in the same class (obrixtamig %17 - gocatamig %44 - tarlatamab %40) have such different response rates, showing that response rate alone cannot support a judgment about the class.
Expanded access program: the only door available today
The manufacturer runs a medical access program opened on 17 April 2026 . The program is currently open but only in one country and six centers; the country is not identified in public records.
Inclusion criteria:
- Age 18 and older, tissue-confirmed extensive-stage small cell lung cancer
- At least two prior lines of systemic treatment (platinum and at least one additional treatment)
- Disease progression on the last treatment
- ECOG performance status 0-1
- Life expectancy of at least three months
Exclusion criteria: Previous use of a B7-H3-targeted agent or antibody-drug conjugate, active brain metastases, history of lung inflammation, uncontrolled heart disease, active HIV / hepatitis B / hepatitis C.
If there are brain metastases: which agents have data?
| Agent | Treatment line | Intracranial data | Data type |
|---|---|---|---|
| ZL-1310 | Line 2. and beyond | Response %80 in patients without brain irradiation (n=32 with brain metastases at baseline) | Phase 1, single-arm |
| Tarlatamab | Line 3. and beyond | Intracranial response %59 · intracranial disease control %94 (n=23) | Phase 2 subgroup |
| Ifinatamab deruxtecan | Line 2. and beyond | Central nervous system response approximately %46 | Phase 2, secondary source |
| Tambotatug pelitecan | Line 2. | Intracranial response %32,4 vs topotecan %2,9 · intracranial PFS 6,1 vs 4,2 months | Phase 3, randomized — strongest design |
| Risvutatug rezetecan | Line 2. | Consistent benefit in the subgroup — separate response rate — | Phase 3 |
| Pumitamig + Elfe-D | All treatment lines | — | — |
| Iza-bren | Line 2. and beyond | — | — |
When reading this table: The figures cannot be compared — the measurement of intracranial response, prior brain irradiation, and study designs differ. The table aims not to rank agents, but to show which agents have no data at all on this issue. When selecting treatment for a patient with brain metastases, whether this column is empty matters more than the size of the figure.
Toxicity: which side effect are you choosing to manage?
Most of these agents are better tolerated than chemotherapy — but pose challenges in entirely different ways. Selection is less about "which causes fewer side effects" than about which side effect is manageable in your center and your patient as the question guiding the choice.
| Agent | Adverse events of grade ≥3. | Discontinuation | Signature toxicity | Treatment-related death |
|---|---|---|---|---|
| ZL-1310 (1,6 mg/kg) | %13 | %0 | Anemia %10, neutropenia %11; ILD only 2 mild cases | 0 |
| Pumitamig + Elfe-D | %23,3 | No dose-limiting toxicity | Digestive effects and blood counts, mostly mild · ILD rate not reported | — |
| Tarlatamab (intravenous) | %27 | %3 | Cytokine release syndrome %60 · neurological %65 · ICANS %10 | %0,4 |
| Tarlatamab (subcutaneous) | Low | %2 | CRS %38 — all mild · injection-site reaction %50 | 0 |
| Gocatamig | %29 | — | CRS %55 · ICANS %7 (all mild) | 1 patient (pneumonitis) |
| Obrixtamig | %24 | 6 patients | CRS %57 (grade ≥3. %3) | 2 patients (neurological) |
| Ifinatamab deruxtecan | %36,5 | — | Lung inflammation %12,4 — %1,5 fatal | %4,4 |
| Lurbinectedin + atezolizumab | %38 | — | Bone marrow suppression | %5 |
| Tambotatug pelitecan | %46,4 | — | Lung inflammation %4,9 (no grade 4.-5.) | 0 |
| Risvutatug rezetecan | %60,9 | — | Lung inflammation %11,7 (no grade 4.-5.) · thrombocytopenia %13,9 | — |
| Sacituzumab govitecan | %74,4 | %0 | Neutropenia %44, diarrhea | — |
| Iza-bren | %75 | %13 | Blood counts + mouth sores · ILD %0 | %3,8 |
| Pumitamig + paclitaxel | %78,6 | %7,1 | Immune and antiangiogenic side effects together | %2,9 |
| Topotecan (comparator) | %62-78 | %6 | Bone marrow suppression | %2 |
1. T-cell engagers — cytokine release syndrome and neurotoxicity. Tarlatamab, gocatamig, obrixtamig. Severe adverse event rates are low, but the monitoring burden is high: after the first two tarlatamab doses, 48 hours of observation is mandatory. This requires bed capacity and an experienced team — it cannot be delivered at every center. The subcutaneous formulation is being developed precisely to ease this burden.
2. Deruxtecan-type ADCs — the lungs. Ifinatamab deruxtecan, and probably elfetabart drozuntecan. The most critical risk is interstitial lung disease. Cases recognized early mostly resolve with treatment interruption and steroids; delayed recognition can be fatal. New cough, shortness of breath, fatigue worsening with exertion, and fever should not wait until the next appointment.
3. Chemotherapy-like ADCs and combinations — bone marrow. Iza-bren, sacituzumab govitecan, and pumitamig combinations. Severe adverse event rates are high (%75-79), but most are manageable and reversible; the discontinuation rate with sacituzumab govitecan is %0. Nevertheless, these agents should be considered for patients with good performance status when choosing treatment.
Approval, access, and cost
| Drug | United States | China | Europe | Japan |
|---|---|---|---|---|
| Tarlatamab | Full approval 19.11.2025 | Approved 10.04.2026 | Approved 29.05.2026 | Approved 27.12.2024 |
| Lurbinectedin | Maintenance approved 02.10.2025 Line 2. being withdrawn |
— | Approved 29.05.2026 (maintenance only) | — |
| Durvalumab (limited-stage) | Approved 04.12.2024 | — | — | — |
| Ifinatamab deruxtecan | Under review — decision 10.10.2026 | — | No (orphan drug) | No (orphan drug) |
| Risvutatug rezetecan | No | Submission accepted 02.09.2026 | No (PRIME) | No |
| Tambotatug pelitecan | No (breakthrough status) | Submission accepted | No | No |
| Iza-bren | No | Approved — but for nasopharyngeal and esophageal cancer (not small cell disease) | No | No |
| Pumitamig · Elfe-D · ZL-1310 · gocatamig · obrixtamig · peluntamig | Not approved in any country | |||
| Serplulimab | No | Approved (line 1.) | Approved 05.02.2025 | No |
| Adebrelimab · benmelstobart | No | Approved (line 1.) | No | No |
| Amrubicin | No | — | No | Approved |
| Topotecan | Globally approved, generic | |||
| Cost (United States) | Unit price | Source type | Estimated periodic cost |
|---|---|---|---|
| Tarlatamab | 10 mg vial 15.099 $ | Pharmacy cash price (not official list price) | In maintenance ~30.200 $/month |
| Lurbinectedin | 4 mg vial 8.580 $ | Official list price, 01.07.2026 | ~17.160 $ / 3-week cycle |
| Topotecan | 1 mg vial 32 $ | Pharmacy cash price | A few hundred dollars per cycle |
The periodic cost calculations are our own and vary with patient weight, treatment duration, and dose reductions. These figures do not apply to Türkiye; the aim is to show the difference in magnitude : one vial of tarlatamab equals approximately 470 vials of topotecan.
Ways to access an unapproved drug
| Route | How it works | Current situation in small cell disease |
|---|---|---|
| Clinical study | Receiving the drug free of charge under a protocol | The most reliable route. ZL-1310's phase 3 accepts patients after tarlatamab; IDeate-Lung02 and DeLLphi-306 are ongoing; ROSETTA Lung-01 includes Türkiye (first-line) |
| Expanded access | Providing an unapproved drug with the manufacturer's permission | Ifinatamab deruxtecan program open — 1 country, 6 centers, narrow criteria |
| Supply from abroad | Bringing in an unauthorized drug through the country's procedures | The drug being approved in another country is usually a prerequisite — this therefore does not apply to the Layer 3 agents in this article |
| Off-label use | Using a drug approved for another cancer here | Sacituzumab govitecan and iza-bren are theoretical examples — but the supporting evidence is small, single-arm phase 1/2 data |
| Regional arrangements | Pilot regions permitting unapproved drugs | China's Hainan Boao Lecheng region operates this mechanism: 101 drugs authorized, %28 subsequently received national approval |
When this article was prepared, technical reasons prevented access to the relevant TİTCK lists; whether tarlatamab and lurbinectedin are authorized in Türkiye could not be verified , and no speculation was made. Because Layer 3 agents are not approved in any country, they are also unauthorized in Türkiye.
The only concrete information verified: pumitamig's first-line phase 3 study ROSETTA Lung-01, across 138 centers in 10 countries, also includes Türkiye.
Four sources to check: the TİTCK SmPC/package leaflet archive, TİTCK Authorized Products List, TİTCK List of Active Ingredients Available from Abroad (unauthorized but available through foreign supply — this is the key place to look), and the TEB Foreign Drug List. Your hospital's medical board unit can perform this search for you.
Decision map: what is available for your situation?
| Your situation | Approved option | Options to investigate | The first question to ask |
|---|---|---|---|
| Limited-stage, chemoradiotherapy completed | Durvalumab consolidation — survival 33,4 → 55,9 months | DeLLphi-306 (tarlatamab consolidation) | "Has consolidation treatment been planned?" |
| Extensive-stage, newly diagnosed | Platinum + etoposide + atezolizumab or durvalumab | ROSETTA Lung-01 (has a center in Türkiye); iza-bren + serplulimab | "Am I eligible for a study?" |
| First-line completed, no disease progression | Lurbinectedin + atezolizumab maintenance | Tarlatamab + durvalumab maintenance (figures not disclosed) | "Is maintenance treatment suitable for me?" |
| Progression after platinum — line 2. | Tarlatamab (global standard) If platinum-sensitive: platinum rechallenge Topotecan |
B7-H3 ADCs; IDeate-Lung02; ZL-1310; iza-bren | "Can our center provide tarlatamab's 48-hour monitoring?" |
| Two lines completed, including tarlatamab | None — chemotherapy remains | Ifinatamab deruxtecan access program; ZL-1310 phase 3 (accepts patients after tarlatamab); pumitamig + Elfe-D (response after DLL3 %70); gocatamig combinations | "Which clinical studies are open to me?" |
| Brain metastases present | Tarlatamab — intracranial response %59 | ZL-1310 (%80 without irradiation); tambotatug pelitecan (randomized data) | "Does this agent have data in brain metastases?" |
| Platinum-resistant disease | Same options, lower expectations | Clinical studies prioritized | "What do these data mean given my platinum sensitivity?" |
| Performance status has declined | Supportive and palliative care prioritized | Most studies and access programs require ECOG 0-1 — these patients are excluded | "Will this treatment help me, or make my remaining time harder?" |
Every study in this article requires ECOG performance status 0-1 in its inclusion criteria. In real life, a substantial proportion of small cell lung cancer patients who have received several treatment lines fall below this threshold.
This has two consequences. First: all the figures above were obtained in patients in relatively good condition, and the same results cannot be expected in a patient with declining performance status. Second, and more importantly: clinical study doors are open before performance status declines. The search for options should therefore not be left until they are needed — starting one treatment line earlier is one of the most effective interventions.
And this must also be said clearly: "There is nothing to do" and "the best thing to do is good supportive care" are not the same statement. Having this conversation early and openly is a valuable intervention for both the patient and family.
Frequently asked questions
- With so many new drugs, why are we still discussing chemotherapy?
- Because approved new agents are limited to the first and second lines, and even these are not available in every country or center. There is no approved new agent after the third line. Older drugs such as topotecan are also inexpensive, widely available, and genuinely effective in some patients; in platinum-sensitive relapse, platinum rechallenge doubles the response rate. Seeking a new agent should not mean rejecting older options.
- Is tarlatamab available in Türkiye?
- We could not verify this because TİTCK records were inaccessible when this article was prepared, and we do not speculate. The drug is approved in the United States, European Union, China, and Japan — even if it is not authorized in Türkiye, foreign supply may therefore be possible. Ask your hospital's medical board unit to check the TİTCK List of Active Ingredients Available from Abroad.
- I was taking lurbinectedin. What happens now?
- The second-line indication is being withdrawn; the first-line maintenance approval remains valid. If you currently take the drug and benefit, the decision to continue belongs to your treatment team. Withdrawal of the indication does not mean "this drug is harming you," but "superiority over chemotherapy was not demonstrated at the group level." Nevertheless, this is a good time to reassess alternatives.
- What comes after tarlatamab?
- There is no approved option today. Three routes can be investigated: (1) the ifinatamab deruxtecan expanded access program; (2) the ZL-1310 phase 3 study — it explicitly accepts patients after tarlatamab, and in phase 1, responses occurred in 3 of 7 patients after tarlatamab; (3) the pumitamig + elfetabart drozuntecan study — response rate %70 in patients previously treated with a DLL3 agent. Chemotherapy is the fourth option.
- Can a second drug targeting the same target work?
- Apparently yes, if the mechanism changes. Tarlatamab targets DLL3 as a T-cell engager; ZL-1310 and gocatamig also target DLL3, but ZL-1310 is an antibody-drug conjugate. Responses with ZL-1310 in 3 of 7 patients after tarlatamab, and with pumitamig + Elfe-D in %70 of patients after a DLL3 agent, are two independent signals in this direction. But both signals involve small numbers; this is a hypothesis, not evidence.
- What is the difference between elfetabart drozuntecan and ifinatamab deruxtecan?
- Both are B7-H3-targeted antibody-drug conjugates and both carry a topoisomerase-1 inhibitor — they belong to the same family. They differ in their antibodies and linker chemistry. Ifinatamab deruxtecan was tested alone, with an FDA decision expected on 10 October 2026; elfetabart drozuntecan's main data in small cell disease were obtained in combination with pumitamig . The two drugs have never been tested against one another.
- What is iza-bren, and what is its role in small cell disease?
- Izalontamab brengitecan simultaneously targets EGFR and HER3 and is a bispecific antibody-drug conjugate. It is approved in China for nasopharyngeal and esophageal cancer — not small cell disease. Its small cell data are phase 1b but striking: in the second-line subgroup, response was %72,7, median survival 15,0 months, and no lung inflammation occurred. This last point is distinctive within the ADC class. However, there is no phase 3 study in small cell disease.
- Is cytokine release syndrome dangerous?
- It occurs in approximately %60 of tarlatamab patients, but the vast majority of cases are mild (grade 1. %45, grade 2. %13, grade 3. %1). It involves fever, chills, and low blood pressure, usually appears with the first doses, and has an established treatment. After the first two doses, therefore, 48 hours of observation is mandatory — the danger lies in the absence of monitoring rather than the syndrome itself.
- Should the risk of lung inflammation frighten me?
- It calls for awareness, not fear. It occurs in %12,4 with ifinatamab deruxtecan, with %1,5 fatal. However, most cases recognized early can be reversed by interrupting treatment and giving steroids. The rule is simple: do not wait for the next appointment if you develop a new cough, shortness of breath, fatigue worsening with exertion, or fever. An interesting comparison: despite belonging to the same class, no lung inflammation occurred with iza-bren, while the rate with tambotatug pelitecan was %4,9 — this risk is molecule-specific rather than shared by the entire class.
- Why are the best figures in Chinese studies?
- Several reasons are possible, and their respective contributions are unknown: patient profile, previous treatments, access to subsequent lines, and genetic differences. The clearest indicator is the comparator arms: the same drug (topotecan) produced survival of 9,4 months in one study and 10,3 months in another. Different populations do not produce identical figures — hence the planned global phase 3 studies.
- Is a drug with a higher response rate better?
- Not necessarily. Two examples: (1) Platinum rechallenge raises the response rate from %25 to %49 but does not change survival at all. (2) Obrixtamig's response rate is only %17-18, but median duration of response is 8,5 months — the longest in this table. A lasting response in a few patients may be more valuable than a two-month response in many. Response rate shows that the tumor has shrunk, not survival time.
- How do I enter a clinical study?
- The first step is to ask your treating oncologist — centers know their own open studies. International registries can be searched using disease and country filters. Note: most studies require ECOG 0-1 , limit the number of previous treatments, and apply exclusions such as active brain metastases and uncontrolled heart disease. It is therefore crucial to start seeking a study while performance status is good rather than delaying the search.
- Do I need DLL3 or B7-H3 testing?
- Not at present. Patients in tarlatamab studies were not selected by DLL3 expression (%95 are already positive), and biomarker selection was not used in B7-H3 ADC studies either. There is no DLL3 or B7-H3 test required in routine clinical practice.
Glossary
- Treatment line
- The order of treatment. First-line is the initial treatment; second-line is treatment given when the first no longer works.
- Maintenance treatment
- Treatment continued after initial therapy is completed and the disease is controlled, to delay its return.
- Consolidation treatment
- Additional treatment given after the main treatment, such as chemoradiotherapy, to reinforce the outcome.
- DLL3
- A surface protein present in most small cell lung cancer cells and almost absent from healthy tissue.
- B7-H3 (CD276)
- A surface protein abundant in tumors but almost absent at the protein level in normal tissue.
- Bispecific T-cell engager
- A drug that binds the tumor at one end and the patient's T cell at the other, bringing them together.
- Antibody-drug conjugate (ADC)
- A cell poison chemically attached to a target-finding antibody. A guided system carrying chemotherapy to the tumor.
- Bispecific ADC
- An antibody-drug conjugate binding two different targets simultaneously. Iza-bren (EGFR × HER3) belongs to this class.
- Cytokine release syndrome (CRS)
- A widespread inflammatory response seen with treatments stimulating immune cells, which may involve fever and low blood pressure.
- ICANS
- Immune effector cell-associated neurotoxicity syndrome. It may present with confusion and impaired attention and speech.
- Interstitial lung disease (ILD)
- Inflammation of the tissue between the lung's air sacs. It is the signature toxicity of some ADC families.
- Step-up dosing
- Giving a very low initial dose and increasing to the target dose with subsequent doses. Intended to lessen cytokine release syndrome.
- Platinum-sensitive / platinum-resistant
- Disease returning more than 6 months after platinum treatment (sensitive) or progressing sooner (resistant). This markedly distinguishes prognosis.
- Objective response rate (ORR)
- The percentage of patients whose tumors shrink measurably on imaging. It shows tumor shrinkage, not survival time.
- Duration of response (DoR)
- How long the response lasts in patients who respond. As important as response rate, sometimes more so.
- Progression-free survival (PFS)
- The time without disease progression.
- Overall survival (OS)
- Survival time itself. The strongest endpoint in oncology.
- Hazard ratio (HR)
- A number comparing the risks in two arms. Below 1 favors the new treatment; HR 0,46 means roughly a %54 risk reduction.
- Accelerated approval
- Conditional approval based on an intermediate outcome such as response rate. A confirmatory study is mandatory; if it fails, the indication is withdrawn.
- Expanded access
- Providing an unapproved drug, with the manufacturer's permission, to patients ineligible for a clinical study.
- ECOG performance status
- A scale rating the patient's ability to carry on daily life from 0 (fully active) to 4 (bedbound). Decisive for study eligibility.
- PDUFA date
- The deadline by which the FDA commits to deciding on a submission. Not a guarantee of approval.
DROZDOGAN Academy Commentary
The 2026 picture in small cell lung cancer can be summed up in one sentence: the top of the map filled up; the bottom remained empty.
⚡ Why it matters
For three decades, there was only one real answer after the first line in this disease. Today, survival in limited-stage disease rises from 33,4 months to 55,9 months, a maintenance treatment has entered the first line for the first time, and a drug has been shown in a randomized study to prolong second-line survival (13,6 versus 8,3 months) with three more agents awaiting approval. This is a concrete change for patients. But the main reason this article exists is: nothing is approved in the third line and beyond , while many agents are being investigated precisely for patients at that line. Making this gap visible is the map's main task.
✅ Where the evidence is strong
Tarlatamab is approved by four major authorities, has converted to full approval, and has a successful confirmatory phase 3 study — the first new-generation agent in small cell disease for which we can say this; it is also both more effective than chemotherapy and less toxic (severe adverse events %27 versus %62). In limited-stage disease, durvalumab consolidation delivered the largest gain in two decades. At WCLC 2026, two B7-H3 phase 3 studies independently produced the same hazard ratio (0,46) , strengthening the target's validity. And although the lurbinectedin news is bad, it shows the system working: the confirmatory study was conducted, the result was negative, and the indication is being withdrawn.
⚠️ Limitations
The greatest limitation is the complete emptiness of the third line. The second is geographical: the two phase 3 studies with the highest figures were conducted entirely in China, compared against topotecan rather than the current standard, and neither is approved anywhere yet. The third is maturity: DeLLphi-305 was announced as "positive," but not a single figure was disclosed; ARTEMIS-008 is an interim analysis; IDeate-Lung02 has no results. The fourth is toxicity: %1,5 fatal lung inflammation with ifinatamab deruxtecan is not negligible, and for pumitamig + Elfe-D, this rate has never been reported. Fifth: all these data were generated in ECOG 0-1 patients; in real life, a substantial proportion of heavily pretreated patients fall outside this group.
🩺 What to do in practice
- As chemoradiotherapy ends in limited-stage disease, ask about consolidation treatment — easy to miss, with a large gain.
- As first-line treatment ends, ask about the maintenance option ; this is now an approved category.
- In the second line, find out whether tarlatamab can be delivered at your center ; 48-hour monitoring cannot be provided everywhere.
- In platinum-sensitive relapse, raise platinum rechallenge — it doubles the response rate, but be aware that it does not prolong survival.
- When a drug is recommended, ask what evidence supports its approval : response rate or survival? Lurbinectedin showed why this question matters.
- If using an ADC-class drug, report new cough and shortness of breath, and if using a T-cell engager, report fever, chills, and changes in consciousness immediately.
- When reading Chinese data, look at the control arm; if its survival does not match your reality, the experimental-arm figure cannot be transferred directly either.
- Investigate clinical studies one treatment line earlier. Most doors close because of the ECOG 0-1 requirement, and once that threshold is crossed, there is no return.
❓ Open questions
What are DeLLphi-305's actual figures? Will ifinatamab deruxtecan be approved on 10 October, and what will its confirmatory phase 3 show? Will the B7-H3 ADC results be replicated outside China? Does targeting the same target again — returning to DLL3 after tarlatamab — truly work; there are two small signals but no evidence. Is combining different classes (T-cell engager + ADC) reasonable; gocatamig + ifinatamab deruxtecan is testing this. What are the duration of response and survival with pumitamig + Elfe-D? Is subcutaneous tarlatamab equivalent to intravenous administration? And specifically for Türkiye: which drugs are authorized, which are on foreign supply lists, and which centers have open studies?
Our brief verdict: 2026 is the year that limited-stage disease, the first line, and the second line began to be addressed in small cell cancer. The third line remains empty — and precisely there, real activity exists with the agents listed in Layer 3 of this article. The approved second-line standard is tarlatamab; beyond it, the most realistic tool available today is not a drug, but a list of clinical studies and an access-program application. The most valuable advice is therefore: do not leave the search for options until the moment you need them.
Points we could not verify or deliberately did not include when preparing this article:
- No numerical result from DeLLphi-305 (median survival, hazard ratio, confidence interval) has been disclosed; only the statement "positive results announced" has been used.
- Authorization status in Türkiye could not be verified for any drug — technical reasons prevented access to TİTCK lists. No speculation was made.
- The list of open clinical studies in Türkiye could not be fully verified; only ROSETTA Lung-01's inclusion of Türkiye could be confirmed. Center names and whether enrollment is ongoing could not be verified.
- For the pumitamig + elfetabart drozuntecan combination, duration of response, progression-free survival, overall survival, and the rate of lung inflammation have not been reported. For an ADC carrying topoisomerase-1, the last item is an important gap.
- A source mix-up: Some news sources described this WCLC 2026 combination study as "pumitamig + ifinatamab deruxtecan." Because both drugs are B7-H3-targeted ADCs, confusion is likely; the developer's release and three independent sources say elfetabart drozuntecan .
- ARTEMIS-008's PFS and response-rate figures, discontinuation rate, and separate intracranial response rate could not be verified; they were left blank in the tables.
- The IMpower133 and CASPIAN figures could not be independently reverified in this round of research; they are widely known published values.
- The CAPSTONE-1 figures could not be independently verified; confirmation from the primary publication is recommended.
- The Chinese approval date for benmelstobart's extensive-stage combination indication, , iza-bren's esophageal cancer approval date, and any efficacy data for peluntamig could not be verified.
- Duration of response and progression-free survival for gocatamig have not been reported.
- Tarlatamab's official list price could not be found; the figure provided is a pharmacy cash price. The periodic cost calculations are our own. Prices and reimbursement status in China could not be verified for any drug.
- SGK / SUT reimbursement information has not been included for any drug.
- Some WCLC 2026 data are at the level of congress presentations and company press releases ; peer-reviewed journal publications have not yet appeared, and figures may change.
- No information in this article replaces personal medical advice or constitutes a treatment recommendation. Treatment decisions are made with your medical oncology team, who know your diagnosis, stage, previous treatments, and general condition.
Sources
- IASLC 2026 World Conference on Lung Cancer, 12-15 September 2026, Seoul. Presidential Symposium and oral session presentations.
- ADRIATIC phase 3 (durvalumab, limited-stage consolidation); FDA approval announcement, 4 December 2024.
- IMpower133 (atezolizumab) and CASPIAN (durvalumab) phase 3 studies, first-line extensive-stage disease.
- ASTRUM-005 (serplulimab) phase 3; European Public Assessment Report (Hetronifly), 4 February 2025.
- CAPSTONE-1 (adebrelimab) phase 3. Lancet Oncology, 2022.
- ETER701 phase 3 (benmelstobart + anlotinib). Nature Medicine, 2024.
- IMforte phase 3 (lurbinectedin + atezolizumab maintenance). The Lancet, 2025; FDA approval 2 October 2025.
- DeLLphi-304 phase 3 (tarlatamab); FDA full approval 19 November 2025.
- DeLLphi-301 phase 2, DeLLphi-303 phase 1b, DeLLphi-308 phase 1b (subcutaneous), and DeLLphi-309 phase 2 (extended-interval dosing).
- Amgen. DeLLphi-305 first-line maintenance result. Press release, 8 September 2026.
- LAGOON phase 3 (lurbinectedin ± irinotecan) and announcement of second-line indication withdrawal, 2026.
- Baize N et al. Second-line comparison of carboplatin-etoposide with topotecan, phase 3. Lancet Oncology, 2020.
- IDeate-Lung01 phase 2 (ifinatamab deruxtecan). Journal of Clinical Oncology, 2025.
- ARTEMIS-008 phase 3 (risvutatug rezetecan), WCLC 2026, 14 September 2026.
- TAISHAN-302 phase 3 (tambotatug pelitecan), WCLC 2026; Roche press release, 13 September 2026.
- BNT324-01 phase 1b/2 (pumitamig + elfetabart drozuntecan), WCLC 2026, abstract OA14.01, 15 September 2026.
- Izalontamab brengitecan phase 1b, recurrent extensive-stage small cell lung cancer. Journal of Clinical Oncology, July 2026; and iza-bren + serplulimab phase 2, ELCC 2026.
- Zai Lab. Updated ZL-1310 phase 1 data. Press release, 24 October 2025.
- TROPiCS-03 phase 2 (sacituzumab govitecan, small cell cohort). Journal of Thoracic Oncology.
- Obrixtamig (BI 764532) phase 1. Journal of Clinical Oncology, 2025. · Gocatamig (MK-6070) phase 1/2, ESMO 2025, abstract 2758MO.
- ROSETTA Lung-01 (NCT06712355) — first-line extensive-stage phase 3, 10 countries including Türkiye.
- Jazz Pharmaceuticals. Zepzelca list-price statement, 1 July 2026. · European Medicines Agency, Imdylltra and Zepzelca EPAR, 29 May 2026.
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