Version July 2025
CT: computed tomography; ECOG: Eastern Cooperative Oncology Group; MRI: magnetic resonance imaging; PS: performance status; SCLC: small cell lung cancer.
* Patients with baseline neuropathy, heart failure, hearing loss, kidney failure, or frailty (ECOG PS 2 or more) are unlikely to tolerate platinum-based doublet chemotherapy.
¶ For those with stable disease or response after chemotherapy, we typically follow up every three months during years 1 and 2, and every six months during year 3. At each visit, we obtain history and physical exam, and CT scans of the chest, abdomen, and pelvis. We also assess brain MRI every three to four months during year 1, and every six months during year 2.
Δ Camptothecins are reasonable alternatives.
◊ We consider tarlatamab to be an acceptable alternative for second-line treatment, but acknowledge that it has only been evaluated in the third-line setting.
§ Further treatment options upon progression on tarlatamab will depend on what the patient previously received. For example, if the patient has not yet received a camptothecin, this would be the preferred option. A number of other agents, including the taxanes vinorelbine, gemcitabine, and temozolomide, have shown activity in patients with relapsed SCLC.