Canadian Consensus Recommendations on the Management of Extensive-Stage Small-Cell Lung Cancer

Barbara L Melosky; Natasha B Leighl; David Dawe; Normand Blais; Paul F Wheatley-Price; Quincy S-C Chu; Rosalyn A Juergens; Peter M Ellis; Alexander Sun; Devin Schellenberg; Diana N Ionescu; Parneet K Cheema

doi:10.3390/curroncol30070465

Canadian Consensus Recommendations on the Management of Extensive-Stage Small-Cell Lung Cancer

Curr Oncol. 2023 Jun 30;30(7):6289-6315. doi: 10.3390/curroncol30070465.

Authors

Barbara L Melosky¹, Natasha B Leighl², David Dawe³, Normand Blais⁴, Paul F Wheatley-Price⁵, Quincy S-C Chu⁶, Rosalyn A Juergens⁷, Peter M Ellis⁸, Alexander Sun^{9

10}, Devin Schellenberg¹¹, Diana N Ionescu^{12

13}, Parneet K Cheema^{14

15}

Affiliations

¹ Department of Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC V5Z 4E6, Canada.
² Department of Medicine, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A8, Canada.
³ CancerCare Manitoba Research Institute, CancerCare Manitoba, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0V9, Canada.
⁴ Department of Medicine, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada.
⁵ Department of Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON K1H 8L6, Canada.
⁶ Division of Medical Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada.
⁷ Department of Medical Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada.
⁸ Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada.
⁹ Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G 2M9, Canada.
¹⁰ Department of Radiation Oncology, University of Toronto, Toronto, ON M5G 2M9, Canada.
¹¹ Department of Radiation Oncology, BC Cancer-Surrey Centre, 13750 96 Avenue, Surrey, BC V3V 1Z2, Canada.
¹² Department of Pathology, BC Cancer, Vancouver, BC V5Z 4E6, Canada.
¹³ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada.
¹⁴ Division of Medical Oncology, William Osler Health System, University of Toronto, Brampton, ON L6R 3J7, Canada.
¹⁵ Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.

Abstract

Small-cell lung cancer (SCLC) is an aggressive, neuroendocrine tumour with high relapse rates, and significant morbidity and mortality. Apart from advances in radiation therapy, progress in the systemic treatment of SCLC had been stagnant for over three decades despite multiple attempts to develop alternative therapeutic options that could improve responses and survival. Recent promising developments in first-line and subsequent therapeutic approaches prompted a Canadian Expert Panel to convene to review evidence, discuss practice patterns, and reach a consensus on the treatment of extensive-stage SCLC (ES-SCLC). The literature search included guidelines, systematic reviews, and randomized controlled trials. Regular meetings were held from September 2022 to March 2023 to discuss the available evidence to propose and agree upon specific recommendations. The panel addressed biomarkers and histological features that distinguish SCLC from non-SCLC and other neuroendocrine tumours. Evidence for initial and subsequent systemic therapies was reviewed with consideration for patient performance status, comorbidities, and the involvement and function of other organs. The resulting consensus recommendations herein will help clarify evidence-based management of ES-SCLC in routine practice, help clinician decision-making, and facilitate the best patient outcomes.

Keywords: PD-1; PD-L1; etoposide; extensive stage small-cell lung cancer; immune checkpoint inhibitors; platinum; radiation therapy.

Publication types

Guideline
Review
Research Support, Non-U.S. Gov't

MeSH terms

Canada
Combined Modality Therapy
Consensus
Humans
Lung Neoplasms* / drug therapy
Small Cell Lung Carcinoma* / drug therapy

Grants and funding

Funding for the development and publishing of this manuscript (expert panel meetings, medical writing support, and journal submission support) was provided by AstraZeneca, Hoffmann-La Roche, and Jazz Pharmaceuticals in the form of unrestricted educational grants. The funder did not participate in expert panel meetings (was not present) and had no role in the writing, editing and submission of the manuscript.