Extensive-stage small-cell lung cancer pharmacotherapy: what is on the horizon?

Extensive-stage small cell lung cancer (ES-SCLC) is yet to be considered an oncologic clinical condition characterized by a dismal prognosis. However, about 5 years ago, the introduction of immunotherapy in the first-line regimens, combined with platin-based chemotherapy, has produced an improvement of survival outcomes for this patient population.

In the last year, two innovative approaches have further improved efficacy outcomes for ES-SCLC patients. The addition of lurbinectedin to the immunotherapeutic drug atezolizumab in the maintenance phase of first-line treatment, and the introduction of the bispecific T-cell engager antibody tarlatamab as second-line treatment, have established two new standards of care for the treatment of ES-SCLC. Moreover, ongoing phase III trials are testing the possibility to introduce tarlatamab in the first-line setting, as induction or as maintenance. Simultaneosusly, phase II trials have reported very promising antitumor activity for ifinitamab deruxtecan and sacituzumab govitecan, two antibody drug conjugates in the second-line setting, and phase III trials are ongoing.

As never in the past, the prognosis of ES-SCLC patients seems characterized by a new light, with innovative drugs that used combined or sequentially, have the potential of a substantial change of the natural history of this aggressive disease.