The NCCN Updates Guidelines for Patients with Small Cell Lung Cancer

Apar Kishor P. Ganti, MD

The National Comprehensive Cancer Network published new guidelines for treating and counseling patients with small cell lung cancer (SCLC) as the field has expanded to allow the first-line treatment of this patient population with immunotherapy along with standard of care chemotherapy.¹

“People with SCLC often experience rapid deterioration but also equally rapid response to treatment,” said Apar Kishor P. Ganti, MD, chair of the NCCN guidelines panel for SCLC, in a press release. “I remember my very first patient entering the hospital in a wheelchair. After his first cycle of chemotherapy, he was able to walk out and have a much better quality of life, and even celebrate an important milestone. This disease is very aggressive and can be a bit of a rollercoaster. I’m grateful to now have this new resource from NCCN to help patients and their loved ones gain a clearer understanding of what to expect.”

While chemotherapy, such as platinum doublet-chemotherapy, remains the classic treatment for patients with SCLC, patients with extensive-stage (ES) SCLC has improved in recent years. One of the main improvements is the addition of immunotherapy for those patients that can’t be treated with high radiation doses that are intended to cure. According to the guidelines, the preferred way to treat patients with ES-SCLC is to give the patient platinum-doublet chemotherapy along with an immune checkpoint inhibitor depending on patient’s test results. Continuation maintenance is also recommended in this patient population as patients can remain on the checkpoint inhibitor after the chemoimmunotherapy regimen.

Patients given atezolizumab [Tecentriq] would receive a dose every 21 or 28 days, whereas patients on maintenance durvalumab [Imfinzi] would receive their dose every 28 days. Preferred initial regimens for patients with ES-SCLC include carboplatin, etoposide, and atezolizumab followed by maintenance atezolizumab; carboplatin, etoposide, and durvalumab followed by durvalumab maintenance; or cisplatin, etoposide, and durvalumab followed by maintenance durvalumab. Radiation therapy can also be an option for certain patients with ES-SCLC, especially if the cancer has spread to the patient’s brain where whole-brain radiation therapy is required. For patients with ES-SCLC, the NCCN recommends the treatment response should be assessed after every to 2 to 3 cycles of systemic therapy after treatment is finished.

“The introduction of immunotherapy as part of first-line treatment for patients with widespread disease has been a big step forward. More trials are underway and we’re hoping to know more about the role of immunotherapy for localized SCLC in the next few years,” Ganti added.

For patients with limited-stage SCLC the goal for treatment is to cure the cancer and chemotherapy is often used with a local treatment, and most patients will receive 4 cycles of platinum-doublet chemotherapy. These treatments are recommended as either cisplatin and etoposide or carboplatin and etoposide. Most patients with limited-stage SCLC will receive chemoradiation but this is dependent on the patient’s performance score. For patients with SCLC at either stage 2B, 3A, 3b, or 3C patients with a performance score of 0, 1, or 2 are recommended for concurrent chemoradiation, in comparison, patients with a 3 or 4 performance score are recommended to be treated with chemotherapy, concurrent chemoradiation, and sequential chemoradiation.

“It’s hard to know what information important or even what questions to ask. These patient guidelines from NCCN give us the scientifically accurate and valid information we need before we try to navigate what’s out there on the internet or hear things from friends,” concluded Deb Violette, president of Free ME From Lung Cancer, in the press release. “People can look through this book on their own time and learn more about what to expect from their treatment course.”

_Reference

_{NCCN Publishes New Guide to Improving Knowledge and Quality of Life for Small Cell Lung Cancer Patients. News release. September 30, 2021. Accessed October 5, 2021. https://bit.ly/3DbQqB6}