Relapsed Refractory Small Cell Lung Cancer (ACR24Case15)-Relapsed Refractory Small Cell Lung Cancer PDF

Relapsed Refractory Small Cell Lung Cancer PDF

Pdf Summary

This educational case, led by Dr. Sally Lau, MPH, focuses on managing relapsed/refractory extensive-stage small cell lung cancer (SCLC) through a patient-centered approach. The case follows Anthony, a 67-year-old man with a heavy smoking history and multiple comorbidities, whose SCLC progressed six months after first-line treatment. He presents with increased fatigue, anorexia, and nausea, alongside extensive intracranial and systemic metastases.<br /><br />Key learning objectives include understanding second-line treatment options for relapsed SCLC, mechanisms of new therapies such as bispecific T-cell engagers, and managing their associated toxicities, specifically cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS).<br /><br />Anthony’s evaluation involved extensive imaging (MRI brain, CT chest/abdomen/pelvis) revealing multiple brain metastases and recurrent cancer in lung, liver, and adrenal glands. Physical exam noted no acute distress or neurological deficits; baseline cognitive and neurological assessments were established.<br /><br />Treatment considerations emphasize rechallenge with platinum-based chemotherapy for platinum-sensitive relapse (>3 months platinum-free interval). Alternatives include oral or IV topotecan, which improves overall survival and quality of life compared to supportive care, and lurbinectedin, showing promising survival data in clinical trials. Notably, tarlatamab, a recently FDA-approved bispecific T-cell engager targeting relapsed/refractory SCLC, exhibits encouraging survival benefits and is recommended by NCCN guidelines.<br /><br />During treatment with tarlatamab, monitoring for CRS and neurotoxicity through ICE assessments is critical, as evidenced by Anthony’s transient grade 1 ICANS episode that resolved with dexamethasone.<br /><br />Follow-up imaging after 30 weeks demonstrated favorable treatment response despite initial toxicities. The case underscores the importance of individualized therapy selection, vigilant monitoring of novel therapy side effects, and applying evolving evidence to optimize outcomes in relapsed/refractory SCLC.<br /><br />In summary, learners gain practical knowledge of current and emerging treatments for SCLC, mechanisms of T-cell engagers, toxicity management, and translating guidelines into clinical decision-making. This microlearning case promotes updated, patient-tailored strategies in thoracic oncology.

Keywords

relapsed small cell lung cancer

refractory SCLC

second-line treatment

bispecific T-cell engagers

cytokine release syndrome

immune effector cell-associated neurotoxicity syndrome

platinum-based chemotherapy rechallenge

topotecan therapy

lurbinectedin

tarlatamab