MyWifeSCLC

It's kinda hard to keep up with those who have SCLC or loved ones with SCLC, especially when this subgroup is not used. It would be nice if a few of you would comment here to let those of us know.
Steve

It's kinda hard to keep up with those who have SCLC or loved ones with SCLC, especially when this subgroup is not used. It would be nice if a few of you would comment here to let those of us know.
Steve

It's kinda hard to keep up with those who have SCLC or loved ones with SCLC, especially when this subgroup is not used. It would be nice if a few of you would comment here to let those of us know.
Steve

It's kinda hard to keep up with those who have SCLC or loved ones with SCLC, especially when this subgroup is not used. It would be nice if a few of you would comment here to let those of us know.
Steve

Hi D iane,
I am so sorry for your loss. I saw your post earlier in the week and was uncertain what to say, as I suspect many feel similar. Please forgive my tardiness in expressing my feelings. I have followed your posts, including reading the ones posted before I became a member. Your posts have helped me focus on my wife's cancer. With the limited number of SCLC cases on here, I suspect we read and reread everything in detail. Please know that I appreciated your willingness to post on this forum.
Thank you ... Steve

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