Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up☆

Dingemans, Anne Marie C.; Früh, Martin; Ardizzoni, Andrea; Besse, Benjamin; Faivre-Finn, Corinne; Hendriks, Lizza; Lantuéjoul, Sylvie; Peters, Solange; Reguart, Noemı́; Rudin, Charles M.; Ruysscher, Dirk De; Schil, Paul Van; Vansteenkiste, Johan; Reck, Martin

doi:10.1016/j.annonc.2021.03.207

Cited by 280 publications

(301 citation statements)

References 104 publications

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“…Some guidelines recommend consolidative thoracic radiation (tRT) in patients with ESCLC with a response to initial chemotherapy but with residual thoracic disease, whereas palliative radiation is routinely used for symptomatic control of metastatic SCLC. 8 , 11 , 12 In the era of immunotherapy, the safety and efficacy of consolidative tRT for ESCLC remain unclear. 13 , 14 Because of the observed synergy between radiotherapy and ICI in the preclinical studies, several clinical trials are now evaluating the safety and efficacy of radiation with immunotherapy in lung cancer, most in the postprogressive disease settings.…”

Section: Introductionmentioning

confidence: 99%

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

Elegbede

Gibson

Fung

et al. 2021

JTO Clinical and Research Reports

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Introduction The real-world data evaluating treatment outcomes of atezolizumab plus carboplatin-etoposide chemotherapy (atezolizumab) for extensive-stage SCLC (ESCLC) are lacking. Our objective was to evaluate real-world outcomes of ESCLC treated with atezolizumab. Methods A retrospective analysis of provincial patients with ESCLC who started first-line (1L) systemic treatment was conducted. We primarily evaluated the progression-free survival (PFS) and overall survival (OS) outcomes in association with atezolizumab compared with platinum-etoposide chemotherapy (chemotherapy) while adjusting for relevant demographic and clinical factors. Adverse events (AEs) during 1L were evaluated. Results A total of 67 patients were identified. Of the 34 patients who received atezolizumab, 24% had Eastern Cooperative Oncology Group performance status greater than or equal to 2, approximately 50% were more than or equal to 65 years, 21% received cisplatin-etoposide chemotherapy before atezolizumab, and 12% had thoracic radiation (tRT). Within the atezolizumab versus chemotherapy group, the median PFS equals to 6.0 versus 4.3 months ( p = 0.03) whereas OS = 12.8 versus 7.1 months ( p = 0.01). Relative to chemotherapy, the hazard ratio (95% confidence interval) for PFS was 0.53 (0.28–1.02) and OS was 0.42 (0.20–0.88) with atezolizumab. tRT compared with no tRT receipt correlated with reduced death risk (hazard ratio [95% confidence interval] = 0.33 [0.13–0.88]). AE-related treatment withdrawal with atezolizumab was 32% and 15% with chemotherapy ( p = 0.02). Within the tRT subgroup, 25% versus 20% in atezolizumab versus chemotherapy group, respectively, discontinued 1L owing to AE. Conclusions This is the first real-world study revealing comparable survival with that in the IMpower133 trial. Treatment discontinuation from AEs was higher with atezolizumab among Canadian patients with ESCLC. Our data suggest safe use of tRT and chemoimmunotherapy, but its efficacy for ESCLC warrants further study.

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Section: Introductionmentioning

confidence: 99%

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

Elegbede

Gibson

Fung

et al. 2021

JTO Clinical and Research Reports

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“…In addition, malignancy tends to enhance after injection of IV contrast [3]. If lung cancer is the most likely diagnosis and curative resectability is in doubt or lung function testing reveals that the patient is not candidate for surgical resection, the histological diagnosis should be confirmed by the least invasive procedure prior to introduce the appropriate chemotherapy or radiotherapy [1,4,5]. In this context, percutaneous biopsy (PNB) of peripheral lung lesions is a less invasive technique that may play a critical role in obtaining pathologic proof of malignancy, guiding staging, and planning treatment with less complications.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations

et al. 2021

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(1) Background: The aim of this study was to conduct a prospective analysis on the diagnostic accuracy of transthoracic ultrasound-guided percutaneous needle biopsy (TUS-PNB) for the histological assessment of peripheral lung lesions and to assess the performance of transthoracic ultrasound (TUS) examination vs. chest CT (gold standard) in the differentiation between malignant and benign peripheral lung lesions. (2) Methods: A total of 961 consecutive patients with subpleural pulmonary lesions were enrolled. All the patients received a CT scan with contrast; 762 patients underwent TUS-PTNB for suspicion of malignancy, and the remaining 199 enrolled patients underwent only TUS examination as a part of routine follow-up for known non-malignant subpleural consolidations. (3) Results: Among the 762 TUS-guided biopsies, there were 627 (82.28%) malignant lesions, 82 (10.76%) benign lesions, and 53 (6.96%) indeterminate lesions. The overall diagnostic accuracy was 93.04%. The rates of pneumothorax not requiring chest-tube insertion and self-limited hemoptysis were 0.79 and 0.26%, respectively. Patients were divided into two groups based on the benign or malignant nature of the subpleural consolidations. On TUS, both malignant and benign lesions showed mostly irregular margins and a hypoechoic pattern, but no differences were assessed in terms of sonographic margins and pattern between the two groups. There was poor agreement between TUS and chest CT in assessing air bronchograms and necrotic areas. The only finding in the detection of which TUS showed superiority compared to chest-CT was pleural effusion. (4) Conclusions: TUS-PNB was confirmed to be an effective and safe diagnostic method for peripheral pulmonary consolidation, but their sonographic pattern did not allow to rule out a malignant nature. A pre-operative evaluation on CT images, combined with the possibility of performing additional immunohistochemical and cytological investigations and the experience of the medical staff, may improve the diagnostic yield of TUS-guided biopsies.

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“…It is staged using the Veterans Administration Lung Study Group (VALSG) staging system, which divides SCLC patients into limited-stage (LS) diseases or extensive-stage (ES) diseases. And according to this staging system, almost two-thirds of patients have ES diseases at diagnosis (2). Even though SCLC is highly sensitive to initial chemotherapy and radiotherapy, the outcomes of newly diagnosed ES-SCLC patients are still very poor, with median progression-free survival (PFS) only about 5-6 months, median overall survival (OS) less than 10 months (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…And according to this staging system, almost two-thirds of patients have ES diseases at diagnosis (2). Even though SCLC is highly sensitive to initial chemotherapy and radiotherapy, the outcomes of newly diagnosed ES-SCLC patients are still very poor, with median progression-free survival (PFS) only about 5-6 months, median overall survival (OS) less than 10 months (2,3). The reason for such poor survival of these patients is that the drug resistance to first-line chemotherapy emerged very quickly and the efficacy of second-line and subsequent therapies is undesirable.…”

Section: Introductionmentioning

confidence: 99%

Survival, Chemotherapy and Chemosensitivity Predicted by CTC Cultured In Vitro of SCLC Patients

Yang

Zhai³

et al. 2021

Front. Oncol.

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PurposeThe prognosis for small cell lung cancer (SCLC) patients receiving later-line treatment is very poor and there is still no standard treatments after the second-line setting. Analyzing the susceptibility of chemotherapeutic drugs with circulating tumor cells (CTCs) cultured in vitro may contribute to optimize the therapeutic regimen. However, so far CTCs have been barely used for studying their chemosensitivity due to the lack of technology to obtain wholly intact and viable CTCs.MethodsBased on a retrospective study of the therapeutic response of 99 patients with unresectable SCLC, the CTC count in 14 SCLC patients was detected before and after chemotherapy to evaluate its role as a potential marker of response. Furthermore, the drug susceptibility of CTCs cultured in vitro obtained from ClearCell FX® System was tested and the therapy response was evaluated.ResultsAll of the 99 patients received the first-line chemotherapy and the objective response rate (ORR) was 74.7%. A total of 36 patients received the second-line therapy and the average duration was 2.6 months, and only 11 cases out of them received the third-line therapy but no one responded. The change of CTC counts was identified to be correlated with therapy response. However all the five SCLC patients who were administered with the drugs according to the drug susceptibility test of CTCs for two cycles underwent progression of disease.ConclusionThe results showed that the responses of chemotherapy are very poor in later lines and the drug susceptibility test using CTCs primary cultured in vitro may not benefit the improvement of therapeutic regimen of SCLC patients.

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Small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up☆

Cited by 280 publications

References 104 publications

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

A Real-World Evaluation of Atezolizumab Plus Platinum-Etoposide Chemotherapy in Patients With Extensive-Stage SCLC in Canada

Effectiveness and Safety of Transthoracic Ultrasound in Guiding Percutaneous Needle Biopsy in the Lung and Comparison vs. CT Scan in Assessing Morphology of Subpleural Consolidations

Survival, Chemotherapy and Chemosensitivity Predicted by CTC Cultured In Vitro of SCLC Patients

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