Treatment of Small Cell Lung Cancer, Extensive Stage (Stage IV) Without Brain Metastases
This protocol addresses subsequent systemic therapy for patients with small cell lung cancer (SCLC) in the extensive stage — Stage IV (T any, N any, M1a/b/c) — who have no localized symptomatic sites and no brain metastases.
Clinical Scenario
- Small cell lung cancer, extensive stage
- Stage IV — T any, N any, M1a/b/c
- No localized symptomatic sites
- No brain metastases
Treatment Goal
Disease response (complete or partial) on CT, assessed after every 2–3 cycles of systemic therapy.
Treatment Approach
Subsequent systemic therapy for patients with PS 0–2 includes both preferred and other recommended options — the complete structured regimen, sequencing, and eligibility criteria are available in the full protocol.
References
Clinical Scenario
- Extensive stage: Stage IV (T any, N any, M 1a/b/c), or T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan.
- Without localized symptomatic sites or brain metastases
Treatment Options
- Tarlatamab-dlle (category 1)
- Irinotecan
- Lurbinectedin (if not previously used)
- If prolonged disease free time, re-treatment with platinum-based doublet with or without immunotherapy
- Topotecan Oral (PO) or Intravenous (IV)
- CAV (Cyclophosphamide/Doxorubicin/Vincristine)
- Docetaxel
- Gemcitabine
- Nivolumab or Pembrolizumab (if not previously treated with an ICI)
- Oral Etoposide
- Paclitaxel
- Temozolomide
Response Assessment
The Panel recommends response assessment using CT with contrast of the C/A/P after every 2 to 3 cycles.
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