How do you approach patients who progress on maintenance atezolizumab after platinum based chemotherapy for extensive stage small cell lung cancer?

At this time I have not yet had this experience. However, the approach should not be very different from that of treating a patient who has progressed after initial chemotherapy with platinum/etoposide who are on observation after having completed 4-6 cycles. If there has been a significant interval...

Clinical trials trump all other options. By the "book," the usual choice, particularly for patients with rapid progression, is topotecan. I prefer oral over IV. Off study, howevever, I will often use temozolomide or weekly taxane in this situation. I share @Dr. First Last's concerns about empiric us...