Department of Medical Oncology, Centro Integral Oncológico Clara Campal (HM-CIOCC), Hospital HM Delfos, HM Hospitales, Barcelona, Spain.
Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
Ann Oncol. 2021 Jun;32(6):698-709. doi: 10.1016/j.annonc.2021.02.025. Epub 2021 Mar 15.
Small cell lung cancer (SCLC) is an aggressive malignancy accounting for 15% of all diagnosed cases of lung cancer. After >15 years without any clinically relevant therapeutic advances, extensive-disease SCLC has become the second thoracic malignancy for which immune checkpoint inhibitors (ICIs) have shifted the treatment paradigm to improve overall survival. Today, atezolizumab or durvalumab in combination with platinum-etoposide chemotherapy is considered the new standard of care in the first-line setting in SCLC. However, the magnitude of benefit with this immune-chemotherapy strategy in SCLC is more modest than that observed in metastatic non-small-cell lung cancer patients. The immunosuppressive phenotype of SCLC plays an important role in hampering ICI efficacy and may explain the differences in outcomes between these two types of lung cancer. In this review, we provide a summary of recent therapeutic advances in SCLC in light of ICIs, as well as current challenges of this strategy in patients who are elderly, have poor performance status or brain metastases. We also address future perspectives of immunotherapeutic strategies currently in clinical development for these patients.
小细胞肺癌（SCLC）是一种侵袭性恶性肿瘤，占所有肺癌确诊病例的 15%。在 15 年以上没有任何临床相关治疗进展的情况下，广泛期 SCLC 已成为第二种胸部恶性肿瘤，免疫检查点抑制剂（ICI）改变了治疗模式，以提高总生存率。如今，阿替利珠单抗或度伐利尤单抗联合铂类依托泊苷化疗被认为是 SCLC 一线治疗的新标准。然而，与转移性非小细胞肺癌患者相比，这种免疫化疗策略在 SCLC 中的获益幅度较小。SCLC 的免疫抑制表型在阻碍 ICI 疗效方面发挥着重要作用，这可能解释了这两种类型肺癌之间的结果差异。在这篇综述中，我们根据 ICI 提供了 SCLC 近期治疗进展的总结，以及该策略在老年、表现状态差或有脑转移的患者中存在的当前挑战。我们还讨论了目前针对这些患者正在临床开发的免疫治疗策略的未来前景。
