What Is the Best Initial Treatment for Small Cell Lung Cancer?

Small cell lung cancer (KHAK) is a neuroendocrine tumor accounting for approximately 15% of all lung cancers, almost all of which are caused by smoking.

Small cell lung cancer cells, compared with non-small cell lung cancer cells, grow and divide faster and undergo earlier metastasis .

At diagnosis, small cell lung cancer is usually stage 4, and the number and variety of drugs available to treat this cancer are smaller than for other lung cancers. Indeed, for 40 years there had been no change in first-line (initial) treatment of advanced small cell lung cancer until atezolizumab (Tecentriq) received FDA approval on 18 March 2019; median overall survival for these patients had been approximately 10 months. In addition, although KHAK responds strongly to both chemotherapy and radiotherapy, despite treatment, within months cancer recurrence occurs.

On 4 October 2019, The Lancet published the CASPIAN study, which brought another new option into consideration for first-line treatment of advanced small cell lung cancer: anti-PD-L1 immunotherapy durvalumab (Imfinzi).

The CASPIAN study enrolled more than 500 patients with advanced disease who had not previously received chemotherapy. Adding durvalumab to the standard platinum+etoposide doublet, compared with platinum + etoposide alone, significantly prolonged survival: 13 months versus 10 months. The survival and side effect results of this study were similar to those of the study that had previously brought atezolizumab FDA approval for first-line treatment of small cell lung cancer, the IMpower133 study .

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NOTE: Durvalumab (Imfinzi) had previously received approval for second-line treatment of advanced bladder cancer in May 2017 and FDA approval in February 2018 for maintenance treatment of unresectable stage III non-small cell lung cancer . This immunotherapy has not yet entered use in our country.