Systemic Therapy for Small-Cell Lung Cancer

Rapid Recommendation Update

Posted online June 4, 2024

Updated Recommendations:

Recommendation 2.4. Patients with LS-SCLC who have completed concurrent chemoradiotherapy and do not have disease progression should be offered consolidation immunotherapy (durvalumab) for up to 2 years if there are no contraindications to immunotherapy. (Evidence quality: Moderate; Strength of recommendation: Strong).

Recommendation 5.3.1. Patients with LS-SCLC and ECOG PS 3-4 due to SCLC who have been treated with concurrent or sequential chemotherapy and radiotherapy may be offered consolidation immunotherapy (durvalumab) for up to 2 years if there are no contraindications to immunotherapy and there is improvement in PS. (Evidence quality: Low; Strength of recommendation: Conditional)

2023 Guideline Abstract

Published ahead of print October 11, 2023, DOI: 10.1200/JCO.23.01435

Humera Khurshid, Nofisat Ismaila, Jessica Bian, Raetasha Dabney, Millie Das, Peter Ellis, Jill Feldman, Christine Hann, Swati Kulkarni, Janessa Laskin, Rami Manochakian, Deebya Raj Mishra, Isabel Preeshagul, Pavan Reddy, Ashish Saxena, Frank Weinberg, and Gregory P. Kalemkerian

Purpose

To provide evidence-based recommendations to practicing clinicians on the management of patients with small-cell lung cancer.

Methods

An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, community oncology, research methodology, and advocacy experts were convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2022. Outcomes of interest included response rates, overall survival, disease-free survival or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guide.

Results

The literature search identified 95 relevant studies to inform the evidence base for this guideline.

Recommendations

Evidence-based recommendations were developed to address systemic therapy options, timing of therapy, treatment in patients who are older or with poor performance status, role of biomarkers, and use of myeloidsupporting agents in patients with small-cell lung cancer.

© 2023 American Society of Clinical Oncology, all rights reserved. For licensing opportunities, contact licensing@asco.org.

Guideline Disclaimer

The Clinical Practice Guidelines and other guidance published herein are provided by the American Society of Clinical Oncology, Inc. (ASCO) to assist providers in clinical decision making. The information herein should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time information is developed and when it is published or read. The information is not continually updated and may not reflect the most recent evidence. The information addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This information does not mandate any particular course of medical care. Further, the information is not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. Recommendations specify the level of confidence that the recommendation reflects the net effect of a given course of action. The use of words like “must,” “must not,” “should,” and “should not” indicates that a course of action is recommended or not recommended for either most or many patients, but there is latitude for the treating physician to select other courses of action in individual cases. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. ASCO does not endorse third party drugs, devices, services, or therapies used to diagnose, treat, monitor, manage, or alleviate health conditions. Any use of a brand or trade name is for identification purposes only.  ASCO provides this information on an “as is” basis and makes no warranty, express or implied, regarding the information. ASCO specifically disclaims any warranties of merchantability or fitness for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions.