Loading
10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Small-cell lung cancer that is still confined to one side of the chest is treated to cure with chemotherapy and radiotherapy given together. Adding two years of the immunotherapy antibody durvalumab afterwards lengthened median survival from under three years to over four and a half, the first improvement in this disease in decades.
Small-cell lung cancer grows fast, spreads early and responds dramatically but briefly to chemotherapy. Limited-stage disease, defined since the 1950s as disease encompassable in one radiation field, is treated with four cycles of cisplatin or carboplatin plus etoposide and concurrent thoracic radiotherapy started with the first or second cycle. Turrisi's trial (1999) showed that 45 Gy in twice-daily fractions over three weeks improved five-year survival from 16 to 26 percent compared with the same dose once daily, and CONVERT (2017) found that 66 Gy once daily was not better than the twice-daily schedule, so both are accepted. Prophylactic cranial irradiation for patients in response cut brain relapse and improved three-year survival from 15 to 21 percent in the 1999 Aupérin meta-analysis, though MRI surveillance is being tested as an alternative because of its effect on memory.
For twenty-five years nothing improved on this until ADRIATIC (2024): 730 patients without progression after chemoradiation were randomised to durvalumab for up to two years, placebo, or durvalumab plus tremelimumab. Durvalumab alone lengthened median overall survival from 33.4 to 55.9 months (hazard ratio 0.73) and progression-free survival from 9.2 to 16.6 months, with pneumonitis of any grade in about a third of patients in both arms. The FDA approved durvalumab consolidation in December 2024 and it has become the standard.
| Setting | Approach | Guideline |
|---|---|---|
| Limited stage, fit | Four cycles of cisplatin or carboplatin plus etoposide with concurrent thoracic radiotherapy (45 Gy twice daily or 60 to 66 Gy once daily) started by cycle two, then durvalumab for up to two years in patients without progression (ADRIATIC). | not mapped |
| After response: brain | Prophylactic cranial irradiation (25 Gy in 10 fractions) or MRI surveillance every three months in patients who decline it or are older; hippocampal avoidance where available. | not mapped |
| Stage I, node-negative, found incidentally | Lobectomy with node dissection then four cycles of platinum-etoposide; radiotherapy if nodes are positive. | not mapped |
| Relapse | As for extensive-stage disease: tarlatamab, lurbinectedin or topotecan, or rechallenge with platinum-etoposide if relapse is late. | not mapped |