What second line treatment would you consider in patients with ES-SCLC with recurrence after front line chemo-immunotherapy?

For patients who have progression of disease while still receiving initial chemo-immunotherapy or maintenance immunotherapy, I do not continue with immunotherapy – there is no rationale for switching to another PD1/PD-L1 inhibitor nor for adding a CTLA-4 inhibitor. If, however, maintenance atezolizu...

There are two FDA-approved options for patients after front-line chemo-immunotherapy. Topotecan was FDA-approved in 1998 with Objective Response Rates (ORR) ranging from 16.9% to 25.0% and Progression-Free and Overall Survivals ranging from 2.7 to 4.1 months and 6.8 to 7.8 months, respectively. (von...

For patients who relapse within 6 months of completing chemoradiation for LS-SCLC, the prognosis is poor. Topotecan has little efficacy in patients with platinum-refractory relapse. Lurbinectedin would be a reasonable option though long-term survival in this setting is not clear. Pembrolizumab would...

I usually approach such cases slightly differently. I choose "90 days of platinum-doublet treatment-free period" to decide my chemo-regimen:

If disease recurrence is within 90 days of completion of platinum-doublet (chemo-free period <90 days)
Lurbinectedin is my preferred regimen based on a phase II...

I treated a patient with Lurbinectedin with extreme toxicity, and therefore, wanted to again review data. It appears that Lurbinectedin is a very reasonable choice in patients who relapse at less than six months from completing chemotherapy and while still on immunotherapy, though some will consider...