Treatment of Extensive-Stage Small Cell Lung Cancer

This chapter discusses first-line and second-line therapy for patients with extensive-stage small cell lung cancer (ED SCLC). As first-line therapy, a platinum agent plus etoposide or irinotecan remains the standard of care for the treatment of SCLC. However, despite an initially high response rate to frontline platinum-based chemotherapy, ED SCLC will universally relapse, often within 3 to 6 months. Topotecan is approved as a second-line treatment for patients with platinum-sensitive, relapsed disease based on symptom control. Patients who receive no further therapy have a median survival of less than 3 months. Despite progress in the understanding of genomic alterations and signaling pathways in SCLC, clinical experiments with tyrosine kinase inhibitors, other small-molecule inhibitors, other antiangiogenic agents have been disappointing. Recently the evaluation of epigenetic modifies, inhibitors of DNA repair and the cell cycle, immune checkpoint inhibitors and inhibitors of the Notch pathway are showing promising efficacy. No new agents with clinically relevant activity have been identified during the last two decades in ED-SCLC, underscoring the unmet need in this area.