The definitions need to be very clear. Chemotherapy refractory disease indicates that the patient had progression while receiving front-line chemotherapy plus checkpoint inhibitor combination. Based on the IMpower133 trial, this is nearly 10% of the patients. In most previous studies, this was aroun...

If the patient truly has refractory disease, progression of disease within the first 90 days, the prognosis is generally poor. Experience with topotecan Second line therapy for both single agent, oral, and intravenous formulation, as well as combination therapy, still have response rates of less tha...