Sequencing Strategies and Integration of Emerging Therapies

Patients with extensive-stage small cell lung cancer (ES-SCLC) can now benefit from a clear treatment sequence that maximizes their chances of longer survival and better disease control. After completing 4 cycles of induction therapy with carboplatin, etoposide, and atezolizumab, patients without progression and good performance status transition to maintenance therapy combining lurbinectedin (3.2 mg/m²) with continued atezolizumab (1200 mg) every 3 weeks, plus preventive granulocyte-colony stimulating factor support to protect blood counts.

This maintenance approach provides patients with significantly longer periods of stable disease, reducing the 6-month progression rate from 41% to 19% and extending overall survival with an HR of 0.73—equivalent to the survival benefits seen with immunotherapy additions in other lung cancer settings. Patients experience meaningful delays in disease progression, with a progression-free survival HR of 0.54, giving them more time with controlled cancer and preserved quality of life before facing the challenges of advancing disease.

When progression eventually occurs, patients can confidently move to established second-line treatments such as tarlatamab without compromising effectiveness. The use of maintenance lurbinectedin doesn't interfere with subsequent therapy options, essentially providing patients with an additional effective treatment phase in their cancer journey. This sequential approach recognizes that most patients with SCLC will not receive multiple lines of therapy due to rapid disease progression, making it crucial to deliver effective treatments proactively while patients remain strong enough to benefit from them.