[New perspectives in the management of small cell bronchial cancer].

Small cell lung cancer (SCLC) remains one of the most aggressive cancers, with an overall survival of approximately one year for patients with extensive stage SCLC, and we still have very few effective therapies, especially after the first line of treatment. A better understanding of SCLC and their mechanisms, especially molecular mechanisms, has led to the exploration of new therapeutic strategies. For example, transcriptomic analyses have identified 4 subtypes of CBPC, which could be predictive of response to treatments. Immune checkpoint inhibitors have shown limited benefit in extensive stage SCLC, but appear to have a clear benefit for limited stage SCLC, in association with radio-chemotherapy. Anti- PARP molecules, involved in DNA repair and aberrantly expressed in CBPC, have been studied. New molecules have been developed, to bypass antigen presentation, which is defective in SCLC; such as bispecific T-cell engager molecules, that binds to SCLC cells and patient's cytotoxic T-cell, leading to T-cell activation and tumor lysis. These molecules target tumor cell's surface proteins, such as delta-like ligand 3 (DLL3), aberrantly expressed on the surface of most SCLC cells. Tarlamab, a DLL3-targeted immune therapy, has shown very promising durable responses in patients with previously treated SCLC. These new molecules lead to new side effects we will have to manage, such as the Cytokine Relargage Syndrome. Other molecules, targeting DLL3 or other pathways are still ungoing clinical evaluation, we should see further advances in the treatment of SCLC over the coming years.