Immune checkpoint inhibitors: a new landscape for extensive stage small cell lung cancer treatment

ABSTRACT

Introduction: Landscape of Extensive Stage (ES)-SCLC treatment has been unchanged over the years. Chemotherapy, mostly based on cisplatin and etoposide, remained the standard-of-care for patients with ES-SCLC for almost 40 years. Recently, immune check points inhibitors have emerged marking a turning point for ES-SCLC treatment

Areas covered: Aim of the paper is to discuss ICIs impact on ES-SCLC treatment algorithms, review current clinical trials, and explore future perspectives.

Expert opinion: A growing body of evidence supports ICI-containing regimens as a new mainstay of ES-SCLC treatment. Whether subgroups of SCLC patients may have greater survival benefits from ICIs treatment needs to be better defined. Understanding the impact of tumor microenvironment and identifying reliable predictive and/or prognostic biomarkers will be fundamental to move toward a personalized treatment approach leading to improved survival.

KEYWORDS:

• ES-SCLC
• chemotherapy
• ICI
• clinical guidelines
• atezolizumab
• durvalumab

Article highlights

• Since 1969 chemotherapy has represented the cornerstone of ES-SCLC treatment; during the eighties, platinum-based and etoposide doublet became the treatment of choice.

• No change in terms of treatment algorithms for almost 40 years.

• ICIs which have revolutionized the cancer landscape, are now also available for treatment of ES-SCLC.

• As of today, two ICIs are FDA and EMA approved for the treatment of treatment-naïve ES-SCLC: atezolizumab (in association with carboplatin + etoposide) and durvalumab (in association with cis/carboplatin + etoposide).

• To fully exploit ICIs, it is essential to identify reliable predictive and/or prognostic biomarkers as well as to better define SCLC tumor microenvironment (TME) to move towards a personalized approach.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.