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So we went into the treatment of limited stage small cell lung cancer, but extensive small cell lung cancer, or basically stage four, is treated in a non-curative setting. The number one key, if you were treated for limited and you recurred is, did you recur within three months of receiving your platinum therapy, which you should have gotten cisplatin. In a stage four extensive setting, if the recurrence occurred within three months, the data doesn’t support rechallenging with that platinum drug, which is the best one in small cell cancer. However, if you relapsed six, nine months out or anything above three, the data suggests rechallenging with a platinum drug can be effective in getting disease controlled again. If you’re diagnosed with extensive small cell or stage four lung cancer outright, and you did not attempt a curative intent with limited small cell lung cancer, there are multiple options on hopefully controlling the disease. Small cell lung cancer unfortunately is pretty aggressive and grows pretty stubbornly. Usually the consensus is the first line therapy now involves a platinum drug, carboplatin or cisplatin. Carboplatin is not used in the curative setting, but usually in extensive, because it’s a little better tolerated, plus immune therapy. That’s going to be your first line and you really hope to sustain a response after four to six cycles of that platinum chemotherapy plus immune therapy and then keep hold on the cancer by doing a maintenance immune therapy dose.
