This protocol addresses central nervous system metastases in patients with small-cell lung cancer (SCLC) presenting with brain metastasis. SCLC has a high propensity for early CNS spread, and the presence of brain metastasis defines a specific sub-population requiring a carefully integrated systemic and cranial strategy.
This regimen applies to patients with confirmed small-cell lung cancer in whom brain metastasis is present. Patients with SCLC should be treated by platinum-based chemotherapy without or with immune checkpoint inhibition — the combination of these two features shapes both the systemic and locoregional management decisions.
The systemic backbone involves platinum-based combination chemotherapy, with or without immune checkpoint inhibition. For patients who achieve a strong response to treatment, an additional cranial intervention may be considered as part of the overall management plan.
DOI: 10.1016/j.annonc.2021.07.016
Patients with SCLC should be treated by platinum-based chemotherapy without or with immune checkpoint inhibition.
The standard of care for patients with extensive SCLC disease is based on platinum and etoposide combination chemotherapy together with immune checkpoint inhibition.
Despite scepticism, PCI is still recommended for patients with limited and extensive-stage SCLC with complete response to chemoradiotherapy.