What treatment would you consider for ES-SCLC that is refractory to first-line platinum plus immunotherapy?  

Updated answer - 01/06/2025Tarlatamab is an ideal drug for this scenario as the mechanism of action is different from chemotherapy.Previous answer - 11/14/2019The definitions need to be very clear. Chemotherapy refractory disease indicates that the patient had progression while receiving front-line ...

Tarlatamab is my go-to in this setting. However, I think there are still good questions about who are the best patients to treat with tarlatamab. Chemorefractory patients are generally ideal for tarlatamab as was stated before, it is a different mechanism of action than chemotherapy and the response...

First of all, I would determine the period of time that progression has occurred since completion of last platinum therapy. For patients who are >/= 6 months from platinum-doublet chemotherapy and especially for patients who tolerated therapy well, I would definitely consider platinum rechallenge...

Subsequent systemic therapy for ES-SCLC may provide palliation with response rates of <10% if the chemotherapy-free interval (CTFI) is less than  6 months (refractory or resistant disease), and approximately 25% if CTFI is more than 6 months (sensitive disease). The European Society for Medi...

If the patient truly has refractory disease, progression of disease within the first 90 days, the prognosis is generally poor. Experience with topotecan Second line therapy for both single agent, oral, and intravenous formulation, as well as combination therapy, still have response rates of less tha...

I generally consider DLL3 TCE for most of my patients given the promising data mentioned above. I do believe areas of uncertainty include: (1) optimal sequencing of DLL3 TCE, and whether these should be considered in first line settings. This is being explored in ongoing trials, (2) the "true" CNS c...