From the Guidelines
The recommended treatment for metastatic small cell lung cancer (SCLC) is platinum-based combination chemotherapy, typically cisplatin or carboplatin with etoposide, administered for 4-6 cycles, and for patients with relapsed SCLC with a chemotherapy-free interval of at least 90 days, rechallenge with a platinum-based regimen or single-agent systemic therapy with preferred agents such as topotecan, lurbinectedin, or tarlatamab may be offered 1.
First-Line Treatment
The initial treatment for metastatic SCLC typically involves platinum-based combination chemotherapy, which has been shown to improve survival and quality of life compared to other treatment options 1. This regimen is often combined with immunotherapy such as atezolizumab or durvalumab for patients with extensive-stage disease.
Second-Line Treatment
For patients with relapsed SCLC, the treatment options depend on the chemotherapy-free interval. According to the most recent guidelines, patients with a chemotherapy-free interval of at least 90 days may be offered rechallenge with a platinum-based regimen or single-agent systemic therapy with preferred agents such as topotecan, lurbinectedin, or tarlatamab 1.
- Topotecan and lurbinectedin are preferred agents for second-line treatment due to their efficacy and moderate evidence quality 1.
- The choice of second-line treatment should be individualized based on performance status, comorbidities, and extent of disease.
- Supportive care, including management of paraneoplastic syndromes and symptom control, is essential throughout treatment.
Key Considerations
- Treatment decisions should be based on the most recent and highest-quality evidence available.
- The chemotherapy-free interval is a critical factor in determining the best course of treatment for relapsed SCLC.
- Platinum-based combination chemotherapy remains the standard of care for first-line treatment of metastatic SCLC.
- Second-line treatment options should be tailored to the individual patient's needs and preferences.
From the FDA Drug Label
ZEPZELCA is indicated for the treatment of adult patients with metastatic small cell lung cancer (SCLC) with disease progression on or after platinum-based chemotherapy. The recommended dosage of ZEPZELCA is 3.2 mg/m2 by intravenous infusion over 60 minutes every 21 days until disease progression or unacceptable toxicity.
The recommended treatment for metastatic small cell lung cancer (SCLC) is lurbinectedin (ZEPZELCA) at a dose of 3.2 mg/m2 by intravenous infusion over 60 minutes every 21 days until disease progression or unacceptable toxicity 2.
- Key considerations:
- Initiate treatment only if absolute neutrophil count (ANC) is at least 1,500 cells/mm3 and platelet count is at least 100,000/mm3.
- Dosage modifications may be necessary for adverse reactions, such as neutropenia, thrombocytopenia, hepatotoxicity, and rhabdomyolysis.
From the Research
Treatment Options for Metastatic Small Cell Lung Cancer (SCLC)
- The treatment for metastatic SCLC typically involves chemotherapy, with platinum-etoposide being a common regimen 3, 4, 5.
- Immunotherapy, such as durvalumab, has also shown promise in combination with platinum-etoposide for the treatment of extensive-stage SCLC (ES-SCLC) 4.
- The choice of platinum agent, either cisplatin or carboplatin, depends on various factors, including the patient's performance status and age 3, 6.
Comparison of Cisplatin and Carboplatin
- Studies have shown that cisplatin and carboplatin have similar efficacy in the treatment of SCLC, with no significant difference in overall survival (OS) between the two agents 3, 6.
- However, carboplatin may have a more favorable toxicity profile, making it a preferred choice for some patients 6.
- A study found that patients aged 70 years and older may have a better OS with carboplatin compared to cisplatin 6.
Efficacy and Safety of Etoposide Plus Platinum
- Etoposide plus platinum (either cisplatin or carboplatin) has been shown to be effective in the treatment of SCLC, with improved objective response rates and disease control rates 5.
- The combination of etoposide and cisplatin has been found to have a better safety profile compared to etoposide and lobaplatin 5.
- Serum levels of pro-gastrin-releasing peptide (ProGRP), neuron-specific enolase (NSE), vascular endothelial growth factor (VEGF), and matrix metalloproteinase-9 (MMP-9) have been found to decrease significantly after treatment with etoposide plus platinum 5.
Second-Line Treatment Options
- For patients with sensitive relapsed SCLC, carboplatin plus etoposide has been shown to be a reasonable second-line chemotherapy option 7.
- Topotecan is also approved for use in the second-line setting for the treatment of SCLC, although carboplatin plus etoposide may have a longer progression-free survival compared to topotecan 7.