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9 treatment settings, 9 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
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.
A CT scan is a fast 3D X-ray that shows the size and shape of tumours and whether they have spread.
PET and CT in one machine, so hot spots on the PET are pinned to exact locations on the CT.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Lobectomy with mediastinal node dissection or SBRT, followed by adjuvant platinum-etoposide; PCI or MRI surveillance.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
Small-cell lung cancer spreads to the brain so often that doctors used to irradiate the whole brain pre-emptively. Regular MRI scans are now challenging that practice.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
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.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.
A PD-L1 blocker that became standard after chemoradiation for stage III lung cancer, and now in bladder, biliary, and gastric cancers.
Small-cell lung cancer spreads to the brain so often that doctors used to irradiate the whole brain pre-emptively. Regular MRI scans are now challenging that practice.
OS 55.9 vs 33.4 months, HR 0.73.
No significant difference; twice-daily 45 Gy remains standard.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Pneumonitis (any cause, PACIFIC) · vs 12.8% placebo; 1.1% fatal | 18.3% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
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.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
A PD-L1 blocker used in lung, liver, and bladder cancer. In 2026 it became the first drug approved based on a blood test showing leftover cancer after bladder surgery.
A PD-L1 blocker that became standard after chemoradiation for stage III lung cancer, and now in bladder, biliary, and gastric cancers.
A marine-derived chemotherapy that jams cancer's gene-reading machinery, approved for relapsed small-cell lung cancer and, since 2025, as first-line maintenance with atezolizumab.
Serplulimab is a Chinese PD-1 antibody with the largest survival gain of any first-line small-cell lung cancer immunotherapy trial, approved in China, Europe, and the UK but not yet the US.
OS 12.3 vs 10.3 months, HR 0.70.
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.
OS 13.2 vs 10.6 months (HR 0.73); PFS HR 0.54.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Pneumonitis (immune-mediated) · Monotherapy pooled | 3% | 0.8% |
| Hepatitis (immune-mediated) · Monotherapy pooled | 1.8% | 0.7% |
| Colitis (immune-mediated) · Monotherapy pooled | 1% | 0.5% |
| Hypothyroidism (immune-mediated) · Monotherapy pooled | 4.9% | 0.2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Pneumonitis (any cause, PACIFIC) · vs 12.8% placebo; 1.1% fatal | 18.3% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan.
The first T-cell engager to improve survival in a common solid tumour, small-cell lung cancer.
A marine-derived chemotherapy that jams cancer's gene-reading machinery, approved for relapsed small-cell lung cancer and, since 2025, as first-line maintenance with atezolizumab.
Topotecan is the long-standing second-line chemotherapy for relapsed small-cell lung cancer, and now the comparator that new drugs must beat.
OS HR 0.60.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Fatigue · DeLLphi-301, n=187 | 51% | 10% |
| Haemoglobin decreased · DeLLphi-301, n=187 | 58% | 5% |
| Decreased appetite · DeLLphi-301, n=187 | 34% | 2.7% |
| Cytokine release syndrome · DeLLphi-301, n=187 | 55% | 1.6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics).
The first T-cell engager to improve survival in a common solid tumour, small-cell lung cancer.
A marine-derived chemotherapy that jams cancer's gene-reading machinery, approved for relapsed small-cell lung cancer and, since 2025, as first-line maintenance with atezolizumab.
Topotecan is the long-standing second-line chemotherapy for relapsed small-cell lung cancer, and now the comparator that new drugs must beat.
Ifinatamab deruxtecan is a B7-H3 ADC showing some of the best response rates ever seen in relapsed small-cell lung cancer.
An alpha-particle version of Lutathera for neuroendocrine tumours that have stopped responding to the beta version.
No headline result recorded yet.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Fatigue · DeLLphi-301, n=187 | 51% | 10% |
| Haemoglobin decreased · DeLLphi-301, n=187 | 58% | 5% |
| Decreased appetite · DeLLphi-301, n=187 | 34% | 2.7% |
| Cytokine release syndrome · DeLLphi-301, n=187 | 55% | 1.6% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
Whole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised.
Stereotactic body radiotherapy converges multiple beams with sub-millimetre accuracy to deliver tumour-destroying doses in one to five outpatient sessions, doing the job of surgery for inoperable early lung cancer and for metastases in liver, spine and brain. Tumour size and location limit its use, and late toxicity is a concern near the central airways.
Small-cell lung cancer spreads to the brain so often that doctors used to irradiate the whole brain pre-emptively. Regular MRI scans are now challenging that practice.
MRI uses a strong magnet and radio waves, with no ionising radiation, to picture soft tissue in finer contrast than CT, so it is the standard scan for brain tumours, prostate, rectal cancer staging, liver lesions and breast screening in high-risk women. It is slow, expensive and blurred by movement.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
Add these to your appointment list, or take the full question set for this cancer.
Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials.
Platinum plus etoposide has been the chemotherapy backbone of small-cell lung cancer for over 40 years, and is now given with immunotherapy.
Osimertinib (Tagrisso) is the standard pill for EGFR-mutant lung cancer, now also given after surgery and with chemotherapy or after chemoradiation.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Decreased appetite · FLAURA | 20% | 2.5% |
| Diarrhoea · FLAURA | 58% | 2.2% |
| Fatigue · FLAURA | 21% | 1.4% |
| Rash · FLAURA | 58% | 1.1% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.
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.
Cisplatin is the original platinum chemotherapy, discovered by accident in 1965; it cures testicular cancer and makes radiation work better in cervical and head and neck cancer.
Carboplatin is a platinum chemotherapy that crosslinks DNA; it is part of the standard pre-surgery regimen for triple-negative breast cancer.
Etoposide is a chemotherapy from the mayapple plant, essential to curing testicular cancer (BEP), treating small-cell lung cancer, lymphomas, childhood sarcomas and leukaemias, and used in transplant conditioning.
A PD-L1 blocker that became standard after chemoradiation for stage III lung cancer, and now in bladder, biliary, and gastric cancers.
A PD-L1 blocker used in lung, liver, and bladder cancer. In 2026 it became the first drug approved based on a blood test showing leftover cancer after bladder surgery.
Specialist care for symptoms, decision-making and quality of life given alongside cancer treatment from diagnosis, not just at the end. Trials show it improves quality of life and mood and may lengthen survival.
OS 55.9 vs 33.4 months, HR 0.73.
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.
OS 12.3 vs 10.3 months, HR 0.70.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Pneumonitis (any cause, PACIFIC) · vs 12.8% placebo; 1.1% fatal | 18.3% | - |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
| Side effect | Any grade | Grade 3+ |
|---|---|---|
| Pneumonitis (immune-mediated) · Monotherapy pooled | 3% | 0.8% |
| Hepatitis (immune-mediated) · Monotherapy pooled | 1.8% | 0.7% |
| Colitis (immune-mediated) · Monotherapy pooled | 1% | 0.5% |
| Hypothyroidism (immune-mediated) · Monotherapy pooled | 4.9% | 0.2% |
Rates from the label or pivotal trial as recorded on the product page; each grade 3+ figure links to its source.
Add these to your appointment list, or take the full question set for this cancer.