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Cancer Therapy AdvisorTherapy Selection in Small Cell Lung Cancer with Disease Progression After Platinum-Based Therapy

In patients with SCLC who have advanced after platinum-based therapy and are ineligible for or unwilling to take part in clinical trials, lurbinectedin is typically recommended over topotecan.

The article delves into the complexities of treating small cell lung cancer (SCLC) after the failure of platinum-based therapies. It highlights the mixed success of immune checkpoint inhibitors (ICIs), the preference for lurbinectedin over topotecan, and the absence of validated predictive biomarkers for platinum resistance. The article also emphasizes the potential of liquid biopsies and the importance of early palliative care, providing insights from Dr. Misty Shields, a thoracic oncologist.

Key Points:

  • Mixed success with ICIs in SCLC, with ongoing investigations to understand underwhelming responses.
  • Lurbinectedin is generally preferred over topotecan for patients who have progressed after platinum-based therapy.
  • Lack of validated predictive biomarkers for platinum resistance represents a significant unmet need.
  • Liquid biopsies are underutilized but likely to have more applications in the coming years.
  • Ongoing clinical trials are investigating alternative treatments for patients unresponsive to platinum-based therapies.

Additional Points:

  • Establishment of effective preclinical models for SCLC research is hindered by the lack of tissue availability.
  • More than 200 trials are actively recruiting for SCLC, including a study investigating abemaciclib in chemo-refractory retinoblastoma wild-type extensive-stage SCLC.
  • Direct comparison of lurbinectedin with topotecan has not yet been performed in ES-SCLC, but lurbinectedin has shown comparable efficacy and a more tolerable toxicity profile.
  • Challenges exist in developing targeted therapies for SCLC, including access to specimens and limitations in preclinical models.


  • The article underscores the need for innovative approaches and continued research to address the challenges in treating SCLC after platinum-based therapy failure, emphasizing the potential of liquid biopsies and the importance of integrating early palliative care.

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“Liquid biopsies will be powerful aids in detecting emerging resistance if the right platforms are employed, not only including exon and the rare intron coverage of these techniques, but also capturing data simultaneously on methylation signatures, subtype classification, and circulating tumor cell enumeration.”

Misty Shields, MD, PhD
Indiana University School of Medicine
Indianapolis, Indiana
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