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A fast-growing lung cancer. About a third of cases are confined to one side of the chest and are treated to cure with chemotherapy and radiotherapy together; the rest respond to chemotherapy and relapse quickly. After 30 years without progress, durvalumab consolidation, the T-cell engager tarlatamab and antibody-drug conjugates have each lengthened survival since 2024.
Small-cell lung cancer is a high-grade neuroendocrine carcinoma, almost always caused by smoking, defined by near-universal loss of TP53 and RB1 and by explosive growth. It presents as extensive-stage disease in two thirds of patients, responds to chemotherapy in most, and relapses in almost all. For three decades the treatment was platinum-etoposide, thoracic radiotherapy for limited-stage disease, prophylactic cranial irradiation, and topotecan at relapse.
The field moved in three steps. First-line chemo-immunotherapy (IMpower133 2018, CASPIAN 2019, ASTRUM-005 2022) added two to five months of median survival and a small tail of long-term survivors. Consolidation durvalumab after chemoradiotherapy for limited-stage disease (ADRIATIC, approved December 2024) was the first curative-intent advance in 30 years, lifting median survival to nearly five years. In relapsed disease, tarlatamab, the DLL3 T-cell engager, became the first drug to beat chemotherapy on overall survival (DeLLphi-304; full FDA approval November 2025), and lurbinectedin plus atezolizumab became the first approved first-line maintenance regimen (IMforte, October 2025).
What is next: maintenance intensification with tarlatamab (DeLLphi-305), the B7-H3 ADC ifinatamab deruxtecan in second line (IDeate-Lung02), alpha-emitting SSTR radioligands (RYZ101), subtype-directed therapy (ASCL1, NEUROD1, POU2F3, inflamed), bispecific and trispecific DLL3 engagers, and the settled question of whether MRI surveillance can replace prophylactic cranial irradiation. Screening remains limited to low-dose CT in smokers, which detects few small-cell cancers early.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Small-cell lung cancer makes up about 15% of lung cancers, roughly 250,000 cases a year worldwide, almost entirely in current or former smokers. Limited-stage disease is treated with curative intent and now with durvalumab consolidation. Both are medians in trial populations, so half of those patients lived longer.
Averages across everyone diagnosed, often years ago. A median is the middle of a group: half the people counted lived longer than the figure shown, and some lived far longer. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Type B3 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Large cell neuroendocrine carcinoma of the lung, Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Most people reading this do not have advanced disease. The map describes what can happen over the whole course of the illness, across autopsy and registry series; today's staging scans find spread earlier, and each site has treatments, from focused radiotherapy for a few spots to drugs that reach the brain.
What helpsChemo-immunotherapy first, then tarlatamab, the DLL3 T-cell engager that improved survival at relapse; MRI surveillance or cranial irradiation protects the brain.
Background: The blood-brain barrier & brain metastasis. Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.
About half of patients without prophylactic cranial irradiation develop brain metastases within 3 years. The reason cranial irradiation or MRI surveillance follows a response.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Low-dose CT screening in heavy smokers finds some SCLC but stage shift is limited; diagnosis by bronchoscopic or CT-guided biopsy; staging with PET/CT and brain MRI.
Lobectomy with mediastinal node dissection or SBRT, followed by adjuvant platinum-etoposide; PCI or MRI surveillance.
Concurrent cisplatin-etoposide with thoracic radiotherapy (45 Gy twice daily or 60-70 Gy once daily), then durvalumab consolidation up to 2 years (ADRIATIC); PCI or MRI surveillance.
Carboplatin-etoposide plus atezolizumab or durvalumab (4 cycles), then maintenance immunotherapy; lurbinectedin added to atezolizumab maintenance since 2025 (IMforte). Serplulimab-chemotherapy where approved. Consolidative thoracic radiotherapy for residual thoracic disease in good responders.
Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan.
Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics).
Whole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised.
Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials.
Small-cell lung cancer moves faster than non-small-cell lung cancer, in both directions: it grows quickly and it shrinks quickly with treatment. NICE NG122 builds that into the standard. It says (1.8.1) to arrange for people with small-cell lung cancer to have an assessment by a thoracic oncologist within 1 week of deciding to recommend treatment, which is a far shorter interval than anything in the non-small-cell pathway, and (1.10.2) to start radiotherapy during the first or second cycle of chemotherapy for limited-stage disease rather than after the chemotherapy is finished. What that means for you is that the decisions arrive close together and the waiting-for-results pattern that suits advanced non-small-cell disease does not apply here. The treatment divides at limited against extensive stage. Limited stage: 4 to 6 cycles of cisplatin-based combination chemotherapy, with carboplatin substituted where kidney function, performance status or other illnesses make that safer (1.10.1); twice-daily radiotherapy given with the chemotherapy for people with a performance status of 0 or 1 whose disease fits in a radical radiotherapy volume, or once daily if they decline or cannot manage twice (1.10.2 and 1.10.3); sequential radiotherapy for people who are not well enough for concurrent treatment but respond to chemotherapy (1.10.4); preventive radiotherapy to the brain at 25 Gy in 10 fractions for performance status 0 to 2 where the disease has not progressed (1.10.5); and durvalumab afterwards where the disease has not progressed after chemoradiotherapy (1.10.6). Extensive stage: platinum-based combination chemotherapy if you are fit enough, to a maximum of 6 cycles depending on response and toxicity (1.11.1 and 1.11.2), with durvalumab or atezolizumab added (1.11.3), and thoracic radiotherapy with preventive brain radiotherapy considered for people who responded (1.11.4 and 1.11.5). NICE is unusually frank about the cost of preventive brain radiotherapy, saying it can adversely affect quality of life and that the survival benefits are limited, and has an open research question about replacing it with regular MRI scans. At relapse it says to offer assessment by a thoracic oncologist (1.12.1), to tell people whose disease did not respond to first-line treatment that there is very limited evidence that second-line chemotherapy will benefit them (1.12.2), to offer an anthracycline-containing or a further platinum-based regimen to a maximum of 6 cycles where chemotherapy is suitable (1.12.3), and to offer radiotherapy for palliation of local symptoms (1.12.5). Because the decisions arrive close together, three things are worth doing in the first weeks rather than later: the palliative care referral alongside treatment, for symptom control and not instead of it; the conversation with your team about what matters to you; and the practical paperwork Roy Castle's getting organised material covers.
Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
The NHS says to call 999 or go to A&E if you are struggling to breathe, if you are choking, gasping and unable to speak, or if you have pain in your chest or upper back. Do not drive yourself.
The NHS says to call 999 or go to A&E if an adult is breathing very fast, is confused, has slurred speech or is not making sense, has blue, pale or blotchy skin, has a very high or very low temperature or feels hot or cold to the touch or shivery, or has a rash that does not fade when you press it.
Sudden severe bone pain, or back pain with weakness or numbness in the legs (possible spinal cord compression).
The NHS says to call 999 or go to A&E immediately if you are coughing up more than just a few spots or streaks of blood, or if you are coughing up blood and finding it hard to breathe, have a very fast heartbeat, or have pain in your chest or upper back.
See all on the product pages:Actinium-225 DOTATATEAnaemiaAtezolizumabCancer-related fatigue (tiredness)CarboplatinCisplatinDurvalumabEtoposideFebrile neutropeniaLurbinectedinMalignant pleural effusion and ascitesNeutropeniaPlatinum + etoposide (EP / CE)SerplulimabSmall-cell lung cancerTopotecan·Printable cards in the navigator
Newly diagnosed? Read the first 60 days with Small-cell lung cancer, then print the one-page appointment sheet with room for the answers.
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Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record.
Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked.