A Review of Monoclonal Antibody Regimens in Small Cell Lung Cancer Compared to Chemotherapy Standard of Care

Background: Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumor closely linked to tobacco use. Chemotherapy with platinum-etoposide is the current standard of care, with positive initial response rates and subsequently high rates of recurrence and death. Monoclonal antibodies are a therapeutic drug class attempting to block suppression of T cell activation, enabling a stronger immune response. Purpose: The current predicament in SCLC treatment is determining if monoclonal antibodies have any effect on overall survival. Chemotherapy briefly suppresses SCLC, but given its rapid progression and recurrence, it is necessary to investigate alternative treatments. The following literature review poses the question: In patients with recurrent or extensive stage SCLC, is monoclonal antibody treatment superior to chemotherapy in overall survival and progression free survival? Secondarily, are objective response rates and patient reported outcomes better in patients treated with monoclonal antibody treatment compared to chemotherapy alone? Methods: A comprehensive literature review was conducted utilizing PubMed. The search terms used were small cell lung cancer, monoclonal antibody, chemotherapy, not NSCLC. Inclusion criteria were randomized control trials including recurrent or extensive stage SCLC patients, published no earlier than 2015, and available in free full text. Exclusion criteria were studies investigating non-small cell lung cancer or other carcinomas and implementing therapy other than monoclonal antibodies. Conclusions: Monoclonal antibodies targeting PD-L1 inhibitors seem to be most effective in prolonging SCLC overall survival. Furthermore, these therapies seem to work best as first line treatment combined with chemotherapy regimens