Does concurrent brain and systemic progression alter your choice of systemic therapy for patients with metastatic SCLC with early progression on chemoimmunotherapy and WBRT?  

This is a challenging situation as is expected when treating most patients with ES SCLC. If I give a patient carboplatin with etoposide and a checkpoint inhibitor and they progress shortly thereafter, the standard treatment options are limited. They include single agent chemo such as topotecan, lurb...

The patient’s age, performance status, tolerance of treatments, and the timing of the relapse is a consideration. Patients who progress while on treatment fare the worst and those who progress in a short period of time after treatment do not do well on a long-term basis. Current NCCN guideline...

I'd have to go back and look at the trials, but irinotecan crosses the BBB, and likely has some intra-cranial activity. Could also consider single-agent irinotecan vs single-agent topotecan in the setting.