This protocol addresses patients with small cell lung cancer (SCLC), extensive stage, who have brain metastases with active, symptomatic neurologic disease.
Initial management for this presentation involved brain radiotherapy — unless immediate systemic therapy was required — combined with corticosteroids, followed by combination chemoimmunotherapy using a platinum-based doublet with an immune checkpoint inhibitor.
This next-line protocol applies when that regimen has not achieved a complete or partial response on CT, has not resolved neurologic symptoms, or has not demonstrated response on brain MRI or CT after the expected number of treatment cycles.
For patients with a performance status of 0–2, subsequent systemic therapy is available across several drug classes, including options with particular relevance for ongoing CNS disease.
The treatment goal is a complete or partial response on CT, assessed after every 2–3 cycles. The full regimen, preferred options, and sequencing algorithm are in the complete protocol.