Recognizing the rapid progression of SCLC, modern clinical trials like PRISM are adopting pragmatic designs. They allow patients to begin initial chemotherapy cycles before official enrollment, ensuring that the need for immediate care does not disqualify them from accessing novel investigational therapies.
Contrary to assumptions that patients avoid difficult news, SCLC patients explicitly want to discuss prognosis. Knowing the treatment's intent—whether curative or palliative—helps them mentally prepare for toxicity, remain motivated during difficult regimens, and engage in crucial end-of-life planning with their doctors.
The long-standing platinum doublet backbone for frontline SCLC may soon be challenged. The high efficacy of novel agents like antibody-drug conjugates and bispecific antibodies in later lines is prompting trials that consider moving them into the first-line setting, a strategy previously considered "unthinkable."
Patient assessment for small cell lung cancer (SCLC) treatment extends beyond the standard ECOG performance status. Clinicians incorporate bone marrow fitness, geriatric tools like the CARC score, and social determinants like caregiver support and transportation to create a holistic and individualized treatment plan.
After standard immunotherapy biomarkers like PD-L1 and TMB proved ineffective in SCLC, the field shifted to a more direct approach. Novel therapies like the bispecific antibody tarlatumab target surface proteins such as DLL3, physically bridging immune cells to cancer cells without relying on predictive biomarkers.