The following questions and responses have been lightly edited for grammatical purposes. 

How does staging work for SCLC?

Dr. Meador: For SCLC, we still describe it as limited stage versus extensive stage.

By definition, limited-stage small-cell lung cancer is something that can be encompassed within a radiation field, meaning it’s potentially curable. Unfortunately, it’s still only curable in maybe about 30% of cases, so it remains a very high-risk disease. But we treat it as potentially curable, unlike extensive stage, which is stage IV.

We do have great new treatments for extensive-stage disease, but those treatments are really aimed at keeping the cancer at bay for as long as possible, not necessarily getting rid of it entirely.

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There’s also a lot of interesting and important work happening in thoracic surgery, looking at whether we can break down small-cell lung cancer into stages I, II, and III. In general, though, at least clinically and in standard care, we still use the categories limited stage versus extensive stage.

Why does SCLC behave so aggressively, and how does that influence the timing of scans and other tests?

Dr. Meador: It’s just a more rapidly dividing tumor. Whether we’re looking at it under a microscope, from a biopsy, or on scans, you can see that it simply grows faster than other types of lung cancer. That’s part of the biology of the disease itself.

Because of that, it’s really important to keep a close eye on it. For most of our small-cell patients, we typically do scans every 8 to 12 weeks, so about every 3 months, including brain MRIs. The reason for that is that we want to stay ahead of the cancer. We have treatment options, but we want to reach for those before patients start feeling sick from the disease.

If SCLC progresses or returns after initial therapy, what should patients expect next?

Dr. Meador: There are two forms of small-cell lung cancer, both of which I treat. One is what we call de novo small-cell lung cancer, which means that’s how the cancer presents at diagnosis. The other is when it develops after a prior treatment for a different type of lung cancer, which is a little more complicated.

Unfortunately, even after the first treatment, we do expect at some point that the cancer may come back or start growing again. The question is really when and how much. That’s when we start looking at what we call second-line therapies.

Definitely ask your doctor about tarlatamab, which was approved in 2024 for SCLC that has progressed after platinum-based chemotherapy. Recent data showed significantly better outcomes with tarlatamab compared to traditional chemotherapy.

There are some logistical challenges with administration, but we can work through those and it’s important that patients know this option exists.

Beyond that, there are several other chemotherapy options that can be used, including lurbinectedin, irinotecan, and temozolomide. These are what we call single-agent chemotherapies, meaning we use one drug at a time. They’re generally less intensive than first-line treatment but can still be effective against SCLC.

From a side-effect perspective, I always tell patients when we’re changing treatments: “Let’s look at what’s on the table. What are our options? What are the risks and benefits?”

Sometimes we’re talking about a 60% response rate; other times, it might be closer to 20%. Sometimes the side effects are minimal; sometimes they’re more significant. So for every potential option, it’s really important to ask:

• How am I going to feel?
• How likely is this to work?

It’s never 100%, and we wish we knew for sure which treatments would or wouldn’t work for each person. If we did, those decisions would be easy. But since we don’t, it comes down to looking at the statistics and then personalizing from there, based on your lifestyle, how you’re feeling, and what you’re up for.

That’s a really important conversation to have with your doctor.

View the full discussion with Dr. Meador here.