Background:Small cell lung cancer (SCLC) remains a highly aggressive malignancy with a poor prognosis. Despite multimodal standard therapies, most patients relapse within months, and second-line treatment options such as topotecan offer only limited benefit. Novel therapeutic strategies are therefore urgently needed.Methods:This narrative review is based on a selective literature search conducted via PubMed and ClinicalTrials.gov (last updated June 2025).Results:Emerging treatment strategies include bispecific T-cell engagers (e.g., tarlatamab), antibody-drug conjugates (ADCs) such as sacituzumab govitecan, DS-7300, and ZL-1310, as well as targeted therapies. Among these, tarlatamab has demonstrated improved survival outcomes with an acceptable safety profile and is poised to become the new second-line standard. In contrast, ADCs and targeted agents have shown only modest efficacy and have yet to deliver meaningful survival benefits, often accompanied by increased toxicity. Additionally, the identification of molecular subtypes of SCLC has revealed subtype-specific differences in treatment response. However, clinical translation is challenged by intratumoral heterogeneity, plasticity, and the lack of standardized diagnostic assays.Conclusions:While tarlatamab represents a major therapeutic advancement, other agents remain in early clinical development and require validation in large, randomized trials. The clinical implementation of molecular subtyping remains limited, though it holds promise for future personalized treatment approaches. Despite recent progress, SCLC continues to pose substantial therapeutic challenges, emphasizing the need for improved treatment strategies and validated predictive biomarkers.
背景：小细胞肺癌（SCLC）仍是一种高度侵袭性、预后不良的恶性肿瘤。尽管采用多模式标准治疗，大多数患者仍在数月内复发，而拓扑替康等二线治疗方案仅能提供有限获益。因此，亟需开发新的治疗策略。 方法：本叙述性综述基于通过PubMed和ClinicalTrials.gov（最后更新于2025年6月）进行的选择性文献检索。 结果：新兴的治疗策略包括双特异性T细胞衔接器（如tarlatamab）、抗体偶联药物（如sacituzumab govitecan、DS-7300和ZL-1310）以及靶向治疗。其中，tarlatamab已显示出可改善生存结局且安全性可接受，有望成为新的二线标准治疗。相比之下，抗体偶联药物和靶向药物疗效有限，尚未带来有意义的生存获益，且常伴随更高的毒性。此外，SCLC分子亚型的识别揭示了治疗反应存在亚型特异性差异。然而，肿瘤内异质性、可塑性以及缺乏标准化诊断检测方法，对临床转化构成了挑战。 结论：尽管tarlatamab代表了治疗上的重大进展，但其他药物仍处于早期临床开发阶段，需要通过大规模随机试验进行验证。分子分型的临床应用仍有限，尽管它有望为未来的个体化治疗提供方向。尽管近期取得进展，SCLC仍面临巨大的治疗挑战，凸显了改进治疗策略和验证预测性生物标志物的必要性。
Redefining the Fight Against SCLC: Standards, Innovations, and New Horizons
肿瘤(癌症)患者之家