How do you approach the management of a patient with extensive small cell lung cancer who has progressed on third-line therapy, with borderline functional status, complicated by paraneoplastic CNS syndrome?

Topics: Thoracic Malignancies • Medical Oncology

Patient has been treated with carbo/etop/atezo, WBRT, and maintenance atezo. Currently on high-dose steroids. Would you consider hospice or trial chemotherapy?

Answer from: Medical Oncologist at Community Practice

Given the overall poor prognosis of small cell lung cancer, I would be inclined to start with a goal of care discussion. Many clinical trials still require ECOG PS 0-1 and I do not believe in "fudging" PS for borderline patients to enroll on a trial. I may consider single agent chemotherapy - lurbin...

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Medical Oncologist at Metro Health Medical Center
Dr. @Erin M. Bertino, thank you for your input. Ve...

Answer from: Medical Oncologist at Academic Institution

I am not sure this patient would qualify for a clinical trial with borderline PS. Standard treatment options are limited, such as Topotecan, lurbinectedin, other single agent chemotherapy but if PS is poor, I would have an honest discussion with the patient, involve palliative care, and likely recom...

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Medical Oncologist at Metro Health Medical Center
Thank you, Dr. @Shadia I. Jalal for your feedback....

Answer from: Medical Oncologist at Academic Institution

Just a point of clarification, I would consider this patient to still be on first-line treatment. Carbo/etop/atezo-->maintenance atezo is really just one line of therapy. The question of benefit from further treatment is more of a clinical gestalt in this setting than truly guideline- or d...

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Medical Oncologist at Metro Health Medical Center
Dr. @Eric C. Anderson, thank you for your feedback...

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