Overview
Small cell lung cancer (SCLC) is an aggressive form of lung cancer, with nearly 60-70% of patients diagnosed at an extensive stage (ES-SCLC). The standard first-line (1L) treatment for ES-SCLC includes platinum-based chemotherapy combined with immunotherapy (IO), followed by IO maintenance (1Lm). However, treatment options beyond 1L remain limited, including lurbinectedin, topotecan, platinum rechallenge (PR), and, more recently, tarlatamab. This study analyzed real-world treatment patterns and patient characteristics using the Flatiron Health electronic health record-derived deidentified database.
Among 2,025 ES-SCLC patients identified between 2020 and 2023, 82% received IO with platinum-based chemotherapy as 1L treatment, and 56% of those continued with IO maintenance. However, only 40% of patients proceeded to second-line (2L) therapy, and 13% to third-line (3L) therapy. Patients who received 1Lm or later-line treatments tended to be younger than those who only received 1L therapy without maintenance. The most common 2L treatment was lurbinectedin (45%), followed by PR with or without IO (28%). For those patients who received 3L, lurbinectedin (32%) and topotecan (22%) were the most frequently used therapies.
Why this matters
This study provides critical insights into how ES-SCLC patients are treated in real-world settings. The findings highlight that few patients proceed to later lines of therapy, suggesting an unmet need for patients with ES disease. Understanding these patterns can help clinicians and researchers identify opportunities to improve patient outcomes, particularly for those who may benefit from additional therapy.