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9 standard-of-care settings across 6 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
| Line | All comers | EGFR |
|---|---|---|
| Screening, prevention and diagnosis | 1 | · |
| Locally advanced | 2 | · |
| Advanced, first line | 1 | · |
| Second line | 2 | · |
| Special situations | 1 | · |
| Other settings | 1 | 1 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Screening and diagnosis | 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. | NCCN · SCLC guideline, staging workup | 92 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Very limited stage (T1-2 N0, ~5%) | Lobectomy with mediastinal node dissection or SBRT, followed by adjuvant platinum-etoposide; PCI or MRI surveillance. | NCCN · 2A | 82 | |
| All comers | Limited stage | 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. | NCCN · 1 (durvalumab consolidation, category 1)ESMO-MCBS · A | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Extensive stage, first line | 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. | NCCN · 1 (chemo-IO); 2A (lurbinectedin maintenance)ESMO-MCBS · 3 | 98 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Relapsed, platinum-sensitive (≥90 days) | Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan. | NCCN · 1 (tarlatamab)ESMO-MCBS · 4 | 94 | |
| All comers | Relapsed, platinum-resistant (<90 days) | Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics). | NCCN · 1 (tarlatamab) | 89 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Brain metastases | Whole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised. | 40 |
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Small-cell lung cancer: why the timeline is faster, and what that means for your decisions | 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. | NICE NG122 (2019, updated March 2024) | 98 | |
| EGFR | Transformed SCLC (from EGFR-mutant NSCLC) | Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials. | 95 |
Chemo-immunotherapy followed by maintenance in small-cell lung cancer gives four cycles of chemotherapy plus immunotherapy, then keeps the immunotherapy going and adds a second drug to hold the disease longer.
Two new relapsed-disease options with different targets and mechanisms. Which comes first, and whether one works after the other, is unknown.
Adding a TIGIT blocker to PD-1/PD-L1 blockade looked good in phase 2 and then failed repeatedly in phase 3.
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.