Hi Diane ... I had already looked at some Extended-stage SCLC info trying to see if any might be have bearing on stage IIIB for my wife.
NCCN Guidelines Version 3.2020: ES-SCLC
1st-line - Cisplatin/Carboplatin + Etoposide + Atezolizumab (Tecentriq), followed by maintenance Tecentriq
2nd-line & beyond:
Refractory/resistant (<3mos) - Topotecan (FDA approved) or clinical trial; other - Nivolumab (Opdivo) w or w/o Ipilimumab (Yervoy); Pembrolizumab (Keytruda); Paclitaxel; Docetaxel; Irinotecan; others.
Note: If maintenance on other immunotherapy (Tecentriq), can't use Opdivo, Yervoy, Keytruda.
Sensitive (>3mos) - Topotecan or clinical trial
Sensitive (>6mos) - Cisplatin/Carboplatin + Etoposide only
NCCN discussion:
Patients w/ progressive disease (PD) while on 1st-line treatment w/ Tecentriq should not be treated with additional immune checkpoint inhibitors.
Patients w/ sensitive relapse - Cisplatin/Carboplatin + Etoposide + Irinotecan improved survival over vs Topotecan but NCCN recommends against it due to toxicity profile.
Literature:
Topotecan for Relapse Small-cell Lung Cancer: Systematic Review and Meta-Analysis of 1347 Patients [Scientific Reports 5:15437 DOI: 10.1038/srep15437 October 21, 2015
Conclusion - Topotecan provided a promising outcome for patients w/ sensitive relapse and poor outcome for patients w/ refractory relapse.
Refractory - 6mos OS@37%; 1yr OS@9%; RR@5%; DCR@29% (CR@0%, PR@3%, SD@25%), PD@59%
Sensitive - 6mos OS@57%; 1yr OS@27%; RR@17%; DCR@42% (CR@1%, PR@14%, SD@22%), PD@48%
Treatment Options for Relapsed Small-Cell Lung Cancer: What Progress Have We Made [American Society of Clinical Oncology, Volume 14/Issue 6/June 2018
"For patients who relapse in < 6 months, we favor single-agent chemotherapy with either topotecan.... or paclitaxel. However, the response rate for topotecan in patients with chemo refractory disease is only approximately 10%, so.... we favor paclitaxel... with response rates of up to 29%.
Overall Survival (OS): Total proportion of patients who are alive after a period of time.
Disease Control Rate (DCR): Total proportion of patients that demonstrate a response. It is the sum of complete response (CR), partial response (PR) and stable disease (SD). Progressive disease (PD) is not part of DCR.
Topotecan Symptoms:
Emergency help needed - hives, difficulty breathing, swelling of face, lips, tongue or throat.
Call Dr. at once - fever, chills, body aches or flu-like symptoms; pale skin, easy bruising or bleeding; unusual weakness; white patches or sores inside mouth or lips; skin changes or severe irritation where needle is placed.
Less serious - bruising or swelling at injection site; tired feeling; headache, body pain, muscular or joint pain; mild skin rash ; loss of appetite; nausea, vomiting, constipation or stomach pain; tempory hair loss.
It looks like 1st-line treatment for ES-SCLC hurts the use of further immunotherapy which is different for LS-SCLC in that immunotherapy is not used in 1st-line treatment. I couldn't find any literature to refute this. However, > 3mos but < 6mos (sensitive) appears to have some alternatives to topotecan. If healthy or "up to it", there is adding irinotecan to CE. Also, I would prefer paclitaxel over topotecan for < 3mos relapse and maybe < 6mos relapse.
Note that a clinical trial for Lurbinectedin is available (I think) for 2nd-line treatment of ES-SCLC patients. You might see if this might work.
I have not been a fan of topotecan but there are more options w/ LS-SCLC than ES-SCLC. I hope this info helps in some small way. I'm pulling for you guys.
Steve