Real-world evidence on second-line therapy in extensive-stage small cell lung cancer

Dr. Maximiliab Hochmair

Extensive-stage small cell lung cancer (ES-SCLC) has a dismal prognosis as patients progress within months after first-line systemic treatment. Until recently, topotecan was the only approved second-line treatment in Europe. Analysis of data from the Austrian LALUCA registry investigated the real-world therapeutic landscape of second-line treatment in ES-SCLC. The analysis included 203 patients with histologically confirmed ES-SCLC diagnosed between November 2020 and October 2025. Among these patients, 75 (36.9%) received second-line therapy. The main reason for no second-line therapy at data cutoff (n=128) was death in 49.2% and switch to best supportive care in 18.8%. Second-line treatment consisted of anthracycline-based treatment regimens in 57.3%, topotecan in 26.7%, and rechallenge of platinum-based chemotherapy or chemoimmunotherapy in 16.0% of patients. The median duration of second-line therapy was 2 months (range 0.0-8.2) with a median progession-free survival of 4.7 months (95% CI 3.9-5.8) and a median overall survival of 7.1 months (5.1-9.3). The median time to next treatment between first- and second-line treatment was 6.4 months9 range 0.3-38.7). The authors conclude that this real-world analysis shows poor outcomes in patients with progressing ES-SCLC, highlighting the urgent need for more effective treatment options.