Small-cell lung cancer is an extremely chemo-sensitive disease; the addition of immunotherapy to chemotherapy has demonstrated a slight clinical benefit in pivotal trials, even with a statistically significant difference in terms of survival outcomes when compared to chemotherapy alone. In this scenario, the role of radiotherapy as a consolidation treatment in thoracic disease or as a prophylactic therapy in the brain should be clarified. In addition, due to the frailty and the poor prognostic characteristics of these patients, the need for predictive biomarkers that could support the use of immunotherapy is crucial. PD-L1 and TMB are not actually considered definitive biomarkers due to the heterogeneity of results in the literature. A new molecular classification of small-cell lung cancer based on the expression of key transcription factors seems to clarify the disease behavior, but the knowledge of this molecular subtype is still insufficient and the application in clinical practice far from reality; this classification could lead to a better understanding of SCLC disease and could provide the right direction for more personalized treatment. The aim of this review is to investigate the current knowledge in this field, evaluating whether there are predictive biomarkers and clinical patient characteristics that could help us to identify those patients who are more likely to respond to immunotherapy.
小细胞肺癌是一种对化疗极为敏感的疾病；在关键性试验中，免疫疗法联合化疗已显示出轻微的临床获益，与单纯化疗相比，在生存结果方面甚至存在统计学显著差异。在此背景下，需要明确放疗作为胸部疾病的巩固治疗或脑部预防性治疗的作用。此外，由于这些患者的虚弱性和不良预后特征，寻找能够支持免疫疗法应用的预测性生物标志物至关重要。由于文献中结果的异质性，PD-L1和TMB目前并未被视为确切的生物标志物。基于关键转录因子表达的小细胞肺癌新分子分类似乎有助于阐明疾病行为，但对该分子亚型的认识仍不充分，临床实践中的应用远未实现；这一分类可能有助于更好地理解小细胞肺癌疾病，并为更个性化的治疗提供正确方向。本综述旨在探讨该领域的现有知识，评估是否存在预测性生物标志物和临床患者特征，以帮助我们识别更可能对免疫疗法产生反应的患者。
The Era of Immunotherapy in Small-Cell Lung Cancer: More Shadows Than Light?
肿瘤(癌症)患者之家