Professor Wang Jie: China's first small cell lung cancer guide came out, the authority led the SCLC diagnosis and treatment.

Affected by the epidemic situation, the 2020 BOC / boa was held online. The meeting mainly included the most important research progress in various cancer fields, the annual research progress in China, and the update and interpretation of the 2020 version of the guidelines. During the meeting, Professor Wang Jie of Cancer Hospital of Chinese Academy of medical Sciences gave a detailed interpretation of CSCO small cell lung cancer 2020 edition.details are as follows.in 2016, the guideline for small cell lung cancer (SCLC) was first compiled as an important part of the guideline for diagnosis and treatment of primary lung cancer. After three revisions in five years, CSCO small cell lung cancer 2020 guideline was finally published independently this year, which is the first professional and authoritative guideline for diagnosis and treatment of small cell lung cancer in China.2020 CSCO SCLC was formulated based on the Chinese leading clinical studies: alter1202 and lobaplatin phase III study; Chinese Participating studies: impower 133 and Caspian studies; the availability of immunotherapeutic agents of atilizumab, navulizumab, pabolizumab and duvalizumab in China and the urgent need for SCLC treatment.the main contents include four parts: diagnosis part, SCLC treatment part, special SCLC treatment part and other parts.the main methods of SCLC staging and diagnosis include chest enhanced CT, abdominal and pelvic enhanced CT, head enhanced MRI or enhanced CT agent whole body bone imaging.the level I recommendation for imaging staging emphasizes head enhanced MRI (type 2A evidence), and level II recommendation emphasizes PET / CT (type 2A evidence).Pet / CT is a better staging method than conventional imaging.for patients with local time limit by conventional imaging methods, 19% of patients with extensive stage and 8% of patients with extensive SCLC turned to limited stage after PET / CT examination.for the detection of biomarkers in patients with limited stage, extensive stage, second-line treatment of SCLC (recurrence within 6 months and more), and third-line treatment of SCLC, grade I recommended ProGRP and NSE detection (type 2A evidence); for patients with second-line treatment of SCLC (recurrence within 6 months), grade III recommended using ngs to detect tumor mutation load (type 2B evidence).the initial treatment of SCLC in partial limited stage was not updated by experts.for patients with stage exceeding T1-2 and N0, chemotherapy + synchronous / sequential radiotherapy (type 1 evidence) is recommended for grade I patients, but the optimal radiotherapy dose and fractionation scheme have not been determined yet. Although hyperfractionated radiotherapy and high-dose radiotherapy have new evidence in ASCO this year, they need to be further verified.the initial treatment of extensive stage SCLC (es-sclc), in recent years, the major progress of small cell lung cancer is mainly reflected in extensive stage SCLC.for the treatment of these patients, the primary stratification factors include no local symptoms and no brain metastasis, local symptoms and whether with brain metastasis.initial treatment for patients with extensive stage SCLC without local symptoms and brain metastases: if PS score is 0-2 or 3-4 (due to SCLC), grade I recommends that etoposide + carboplatin + atilizumab is preferred after 4 cycles of sequential atilizumab maintenance therapy (type 1A evidence).other recommended chemotherapy regimens include etoposide + cisplatin or carboplatin (type 1 evidence), irinotecan + cisplatin or carboplatin (type 1 evidence).grade III recommends sequential dovalizumab + etoposide + carboplatin or cisplatin after 4 cycles (type 1A evidence). for asymptomatic brain metastases, level I experts recommend EC + atilizumab regimen followed by whole brain radiotherapy (type 1A evidence) or EP / EC / IC regimen followed by whole brain radiotherapy (type 2A evidence). grade III is recommended as dovalizumab + etoposide + carboplatin or cisplatin, followed by whole brain radiotherapy (type 1A evidence). for patients with symptomatic brain metastases, grade I experts recommend whole brain radiotherapy first, then EC + atilizumab regimen (type 1A evidence) or whole brain radiotherapy first, and then EP / EC / IP / IC scheme (class 2A evidence) after symptoms are stable. grade III is recommended as whole brain radiotherapy followed by dovalizumab + etoposide + carboplatin or cisplatin (type 1A evidence). this guideline update is mainly based on the results of impower 133 study and Caspian study, both of which adopted the combination of PD-L1 inhibitor and chemotherapy. The two studies confirmed each other, and the research results were similar. The combined immunotherapy improved the overall survival (OS) by more than 2 months. Although the two months were still unsatisfactory, it was also a great progress in the treatment of small cell lung cancer in the past 40 years Further exploration of biomarkers is needed in order to screen the population who benefit from immunotherapy. on March 19, 2019, atelizumab combined with carboplatin and etoposide was approved by FDA for the treatment of patients with extensive stage SCLC. On February 13, 2020, nmpa approved the indication of this regimen for the first-line treatment of extensive SCLC. on March 30, 2020, FDA approved dovalizumab combined with chemotherapy as the first-line treatment for patients with extensive SCLC. second line treatment of recurrent SCLC. For second-line treatment, it is generally stratified according to the time from the last chemotherapy to the recurrence: if the recurrence is less than 6 months, topotecan (type 1 evidence) or clinical trial is recommended for grade I, irinotecan, paclitaxel, docetaxel, gemcitabine, oral etoposide, vinorelbine, and temozolomide (all type 2A evidence) are recommended for grade II Bendamustine (class 2B evidence) was recommended. if the recurrence is more than 6 months, it is recommended to choose the original protocol (not applicable to the first-line application of immune drugs, because of the lack of research evidence). it is recommended to use carboplatin or cisplatin + etoposide again for patients who relapse after more than 6 months of maintenance therapy with atilizumab or dovalizumab. for patients with PS 0-2, grade I is recommended to be anlotinib (type 2A evidence), and level II is recommended to refer to clinical trials, navulizumab (type 2A evidence), and pabolizumab (type 2A evidence) for patients with PS 0-2. the alter1202 study is the only multicenter clinical study of three-line and above SCLC treatment with positive results compared with placebo. It is of great significance to improve the treatment dilemma of SCLC. In 2019, anlotinib approved the indications of third line treatment of SCLC with anlotinib. the research results of alter1202 have appeared on the international stage in the form of oral reports or wall papers for many times, including data from multiple subgroups. Results: wclc oral report in 2018, ESMO oral report in 2019, brain metastasis subgroup in 2019wclc (wall Report), chest radiotherapy subgroup in 2019wclc (wall report), quality of life subgroup (wall report) in 2019wclc and 2020 Subgroup data of short-term recurrence after second-line treatment of ASCO (wall report). treatment of special SCLC the treatment of this part of patients is the highlight of this guideline update, and the treatment of complex SCLC is recommended as a separate part for the first time. compound SCLC (c-sclc) refers to the mixture of SCLC and NSCLC components. The peripheral type of c-sclc accounts for about 50%, and 70% of patients are in limited period. Compared with simple SCLC, c-sclc with surgical treatment has more significant benefit. For c-sclc with mixed adenocarcinoma components, gene detection is needed. C-sclc combined with driving gene mutation has potential benefits. for the treatment of complex SCLC, pure SCLC is recommended for the treatment of grade I / II. grade III recommendations: 1. Multidisciplinary team discussion is recommended for patients with reduced lesions after treatment, and surgical treatment can be considered for patients who can be completely resected according to clinical judgment (3 types of evidence); 2. For c-sclc with adenocarcinoma, gene detection is recommended, and targeted therapy (type 3 evidence) can be considered for those with driver gene mutation; 3 Repeated biopsy should be encouraged after drug resistance treatment (3 types of evidence); 4. Participation in clinical trials should be encouraged. this guideline update adds the recommendation of transformational SCLC for the first time. translational SCLC is one of the mechanisms of drug resistance in NSCLC patients. 5% - 14% occurred in EGFR mutation NSCLC patients after TKI treatment. SCLC transformation was also reported in ALK positive patients after TKI treatment and immunotherapy. most of the transformed SCLC (about 83%) retained the gene mutation of the original pathological type of lung cancer, and had the gene characteristics of TP53 and RB1 deletion mutation. for the prediction of SCLC transformation, level III is recommended to detect serum NSE, ProGRP (type 3 evidence) or Rb1, TP53 gene (class 2B evidence). for the treatment of these patients, first of all, according to the progress of EGFR TKI treatment, for patients with rapid progress of the system, level II is recommended as the standard SCLC chemotherapy scheme (three types of evidence), and for patients with local slow progress or slow system progress, level III is recommended as standard SCLC chemotherapy regimen or continue with the original EGFR TKI + local treatment (Level 3 evidence) and standard SCLC chemotherapy regimen + continuation of original EGFR TKI treatment (type 3 evidence). the significance of CSCO SCLC guidelines for the treatment of large cell neuroendocrine tumors