NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018

Kalemkerian, Gregory P.; Loo, Billy W.; Akerley, Wallace; Attia, Albert; Bassetti, M.; Boumber, Yanis; Decker, Roy H.; Dobelbower, M.C.; Dowlati, Afshin; Downey, Robert J.; Florsheim, Charles; Ganti, Apar Kishor; Grecula, J.C.; Gubens, Matthew A.; Hann, Christine L.; Hayman, James A.; Heist, Rebecca S.; Koczywas, Marianna; Merritt, Robert E.; Mohindra, Nisha; Molina, Julian R.; Moran, César A.; Morgensztern, Daniel; Pokharel, Saraswati; Portnoy, David C.; Rhodes, Deborah J.; Rusthoven, Chad G.; Santana-Dávila, Rafael; Williams, Charles C.; Hoffmann, K; Hughes, Miranda

doi:10.6004/jnccn.2018.0079

Cited by 225 publications

(188 citation statements)

References 48 publications

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“…described the occurrence of brain metastases during p‐stage I disease at 6.25% (2/32) . The NCCN guidelines endorse concurrent chemotherapy and PCI for such patients based on evidence in limited stage SCLC patients . However, the use of PCI in p‐T1‐2N0M0 SCLC is continually questioned based on the evidence of a comparatively low risk of brain relapse.…”

Section: Discussionmentioning

confidence: 99%

“…However, its use on patients without lymph node involvement remains controversial . The National Comprehensive Cancer Network (NCCN) and European Society for Medical Oncology (ESMO) guidelines endorse PCI therapy in patients fitting this diagnosis based on evidence in limited stage SCLC patients . Several retrospective reports have demonstrated the benefits of PCI therapy in prolonging overall survival (OS) and reducing the probability of brain metastases for completely resected SCLC with p‐N1‐N2M0, but there is less evidence for its use in patients without lymph node involvement.…”

Section: Introductionmentioning

confidence: 99%

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Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Lou

Zhong

et al. 2020

Thoracic Cancer

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Background It has previously been demonstrated that surgically resected small‐cell lung cancer (SCLC) patients could benefit from prophylactic cranial irradiation (PCI). However, PCI in patients without lymph node involvement remains controversial. This study includes a larger sample size to evaluate the benefit of PCI therapy in this specific population. Methods The records of surgically resected SCLC patients without lymph node involvement (N0M0) in Shanghai Chest Hospital were retrospectively reviewed. Results Between January 2006 and May 2017, a total of 146 cases of surgically resected SCLC without lymph node involvement were included. A total of 46 patients received PCI therapy and 100 patients received no therapy. During the observation period, 12.0% (12/100) of the patients who did not receive PCI therapy developed brain metastases while 10.9% (5/46) of patients who received PCI therapy developed brain metastases. With regard to time to recurrence, no significant difference was observed among the groups (P = 0.798). Moreover, there was no significant difference in either the overall survival benefit (hazard ratio [HR] = 0.84, 95% confidence interval [CI]: 0.49–1.45, P = 0.532) or disease‐free survival rate (HR = 0.95, 95% CI: 0.52–1.75, P = 0.864). Conclusions The evidence obtained does not support PCI therapy in the management of surgically resected SCLC with no lymph node involvement. Key points Prophylactic cranial irradiation (PCI) remains controversial for resected small‐cell lung cancer (SCLC) without lymph node involvement. In this study, the results indicated that PCI does not reduce the risk of cerebral recurrence of resected p‐T1‐2N0M0 SCLC. This is the largest sample size study focused on PCI in resected p‐T1‐2N0M0 SCLC. Future revised versions of the guidelines should address this issue.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Lou

Zhong

et al. 2020

Thoracic Cancer

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“…Today, PCI is recommended for patients in complete remission after systemic treatment for limited or even disseminated disease (6). In a recent survey amongst US radiation oncologist, 98% will recommend PCI but only after a brain magnetic resonance imaging (MRI) in the initial staging (7).…”

Section: Review Articlementioning

confidence: 99%

Prophylactic cranial irradiation (PCI) or magnetic resonance imaging (MRI) monitoring in limited small cell lung cancer: is it a question?

Houtte¹,

Roelandts²,

Charlier³

et al. 2019

Precis Cancer Med

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Brain metastases are a major problem in the management of small cell lung cancer (SCLC) with an incidence rising to 50% at 2 years. Prophylactic cranial irradiation (PCI) has shown through randomized trials and meta-analysis to decrease the incidence of brain metastases by 25% leading to a 5% survival benefit at 3 years for patients in complete response to the initial therapy. The major concern with PCI is the risk of inducing neurologic symptoms, especially cognitive functions, and an impaired quality of life. In extensive disease SCLC, an active surveillance with magnetic resonance imaging (MRI) has questioned the value of routine PCI challenging its use for limited disease. In this paper, we will review some main limitations of the different randomized trials, the impact of new technologies and the data available on the possibility to omit (or not) PCI for limited disease.

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“…New cancer drugs against small-cell lung cancer (SCLC) have been awaited because the 3-year survival of extensive-disease SCLC (ED-SCLC) is below 5% 1 . The standard first-line treatment for ED-SCLC is platinum chemotherapy using etoposide or irinotecan 2 . Recently, the addition of atezolizumab, an anti PD-L1 antibody, to standard chemotherapy improved the overall survival and progression-free survival 3 .…”

Section: Introductionmentioning

confidence: 99%

MCL1 inhibition is effective against a subset of small-cell lung cancer with high MCL1 and low BCL-XL expression

et al. 2020

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There have been few advances in the treatment of small-cell lung cancer (SCLC) because of the lack of targets. MCL1, a member of the anti-apoptotic BCL-2 family, may be a treatment target in several cancers, including SCLC. However, whether the expression profile of the anti-apoptotic BCL-2 family affects MCL1 inhibition strategy is unknown. A tissue microarray (TMA) was created from consecutive patients who were diagnosed with SCLC and had previously undergone surgery at Kyoto University Hospital (Kyoto, Japan) between 2001 and 2017. We used S63845, a MCL1 inhibitor, to assess the cytotoxic capacity in SCLC cell lines including a patient-derived cell line in vitro and in vivo. The combination of S63845 with navitoclax, a double BCL-X L /BCL-2 inhibitor, was also employed to examine the comprehensive inhibition of the anti-apoptotic BCL-2 family. Immunohistochemistry of a TMA from patients with surgically resected SCLC demonstrated high MCL1 expression with low BCL-X L and BCL-2 to be the most common expression profile. S63845 was effective in high MCL1-and low BCL-X L -expressing SCLC cell lines. S63845 induced BAKdependent apoptosis in vitro, and the anti-tumor efficacy was confirmed in an in vivo model. Although knockdown of BCL-X L and BCL-2 improved the cytotoxic activity of S63845 and its combination with navitoclax increased the antitumor cytotoxicity, the therapeutic range of S63845 with navitoclax was narrow in in vivo studies. Our study suggests MCL1 inhibition therapy be applied for high MCL1-and low BCL-X L -expressing SCLC patients.

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NCCN Guidelines Insights: Small Cell Lung Cancer, Version 2.2018

Cited by 225 publications

References 48 publications

Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Does surgically resected small‐cell lung cancer without lymph node involvement benefit from prophylactic cranial irradiation?

Prophylactic cranial irradiation (PCI) or magnetic resonance imaging (MRI) monitoring in limited small cell lung cancer: is it a question?

MCL1 inhibition is effective against a subset of small-cell lung cancer with high MCL1 and low BCL-XL expression

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