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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.
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).
| Setting | Approach | Guideline |
|---|---|---|
| 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 |
| 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 |
| 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 |
| 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 |
| Relapsed, platinum-sensitive (≥90 days) | Tarlatamab (preferred, OS benefit); platinum-etoposide rechallenge; lurbinectedin; topotecan. | NCCN 1 (tarlatamab), ESMO-MCBS 4 |
| Relapsed, platinum-resistant (<90 days) | Tarlatamab; lurbinectedin; topotecan; clinical trials (I-DXd, RYZ101, DLL3 bispecifics). | NCCN 1 (tarlatamab) |
| Brain metastases | Whole-brain radiotherapy or, increasingly, stereotactic radiosurgery for limited numbers of lesions; PCI decisions individualised. | not mapped |
| Transformed SCLC (from EGFR-mutant NSCLC) | Platinum-etoposide, often with continued EGFR TKI; immunotherapy benefit uncertain; trials. | not mapped |