Gegenwärtiger Einsatz und aktuelle Entwicklungen der Immuncheckpointinhibition beim metastasierten und lokalisierten kleinzelligen Lungenkarzinom

Small cell lung cancer (SCLC) is characterized by aggressive proliferation kinetics, early development of distant metastasis, and an overall dismal prognosis. Addition of the PD-L1 antibodies atezolizumab and durvalumab to platinum-/etoposide-based chemotherapy improves overall survival and represents the first change in therapeutic standards for almost 30 years in metastasized SCLC (stage IV or extensive disease [ED] according to the Veterans Administration Lung Study Group [VALG]). Although the numeric gains in median overall survival are limited (approximately 3 months), the addition of a PD-L1 antibody led to a clinically relevant increase in 3-year overall survival from 5.8 to 17.6%. Therefore, anti-PD-L1-based immunochemotherapy represents the current standard for ED-SCLC and should be applied irrespective of PD-L1 expression and other biomarkers. Standard of care in curatively treatable SCLC limited to the hemithorax (limited stage [LD] according to VALG) remains is accelerated concurrent chemoradiotherapy. The recently presented findings of the ADRIATIC study demonstrate a benefit from consolidation therapy with the PD-L1 antibody durvalumab. A corresponding expansion of the drug's approval can be expected. In conclusion, treatment of SCLC remains a challenge and improvements in therapeutic standards are much slower than those seen in NSCLC.