Lung cancer has always been the “biggest” in terms of the number of cases and deaths, and small cell lung cancer is extremely difficult to deal with among all types of lung cancer. Strictly speaking, small cell lung cancer is not a lung disease, but a systemic disease. In the traditional treatment mode, small cell lung cancer treatment mainly relies on chemotherapy and radiotherapy. With the development of immunotherapy, small cell lung cancer treatment The pattern has changed a bit.
Today’s roundup of all treatments for small cell lung cancer.
1. Chemotherapy
With the announcement of the 2022 CSCO guidelines, there are not many highlights and updates on chemotherapy drugs and regimens for small cell lung cancer. Chemotherapy regimens are usually first-line regimens using irinotecan or etoposide in combination with platinum (cisplatin, carboplatin, lobaplatin). Second-line regimens can choose topotecan, paclitaxel, docetaxel, gemcitabine, vinorelbine, temozolomide and other chemotherapy.
Because of the high bone marrow toxicity of chemotherapy drugs for small cell lung cancer, this year’s CSCO guidelines have added the recommendation of the chemoprotective drug tralacilide. Tralaciride is a short-acting CDK 4/6 inhibitor indicated to reduce the incidence of myelosuppression in patients with extensive-stage small cell lung cancer receiving certain types of chemotherapy.
Small cell lung cancer has high chemosensitivity, and the recent treatment effect is good, but due to the short doubling time of cancer cells, the remission period is often relatively short, and many patients reappear after a few months of maintenance progress. Therefore, postoperative adjuvant radiotherapy is required for patients with positive lymph nodes after radical surgery. For patients with limited-stage disease who have not undergone surgery, guidelines recommend simultaneous or sequential radiotherapy.
2. Immune drugs
Although there are more than a dozen varieties of PD1/PDL1 immune checkpoint inhibitors, the number of immune drugs recommended by real guidelines and approved by the state for small cell lung cancer is relatively limited. Take O drug, for example, in August 2018, FDA approved O drug nivolumab for the third-line treatment of small cell lung cancer, but the two confirmatory phase III clinical trials failed, so in December 2020, O drug targeted small cell lung cancer. The indication for cell lung cancer was withdrawn. The same is true for K drug. The KEYNOTE-604 phase III clinical study showed that pembrolizumab combined with chemotherapy in the first-line treatment of small cell lung cancer can reduce the risk of disease progression (4.5 months vs 4.3 months), but there was no significant difference in OS. For this reason, On March 1, 2021, Merck voluntarily withdrew the indication of pembrolizumab for extensive-stage small cell lung cancer.
The immune drugs recommended by the guidelines for small cell lung cancer are all imported PD-L1 inhibitors, one is durvalumab and the other is atezolizumab. In March 2019, the FDA approved atezolizumab (Taishengqi, T drug) in combination with the chemotherapy drugs carboplatin and etoposide for the first-line treatment of extensive-stage small cell lung cancer. The first immunotherapy drug to treat. In the IMpower133 study, atezolizumab + carboplatin + etoposide prolonged median OS (12.3 vs 10.3 months) and median PFS (5.2 vs 4.3 months) compared to placebo + carboplatin + etoposide ). In fact, overall survival was also extended by 2 months.
Durvalumab (Infineon, I drug) was approved by the FDA in March 2020 for the first-line use of extensive-stage small cell lung cancer. In the CASPIAN Phase III clinical study, the degree of Valimumab combined with chemotherapy can reduce the risk of death by 27% in patients with extensive-stage small cell lung cancer, increase the objective response rate to 68%, and achieve a median OS of 13.0 months, achieving the longest history in the treatment of extensive-stage small cell lung cancer. of overall survival.
In the latest version of the CSCO guidelines in 2022, a new domestic immune drug is recommended (level III recommendation), which is called slulimumab. In the phase III ASTRUM-005 study, the median overall survival was 15.38 months in the slulimumab group and 11.10 months in the placebo group, and slulimumab reduced the risk of death by 38% in patients with small cell lung cancer , the 2-year overall survival rate (OSR) was 43.2% in the slulimumab group and 8.0% in the placebo group. In a subgroup analysis, slulimumab reduced the risk of death by 41% in patients with small cell lung cancer in Asian populations.
3. Targeted drugs
Small cell lung cancer rarely has sensitive gene mutations, so it is impossible to have as many targeted drugs as adenocarcinoma. At present, only the multi-target anti-angiogenesis drug Anlotinib is the only targeted drug recommended by the guidelines, which is recommended as a third-line or above drug.