Prophylactic cranial irradiation for small cell lung cancer in the era of immunotherapy and molecular subtypes

Pozonec, Veronika and Pozonec, Maria Dorothea and Aigner, Clemens and Widder, Joachim and Boettiger, Kristiina and Megyesfalvi, Zsolt and Dome, Balazs (2024) Prophylactic cranial irradiation for small cell lung cancer in the era of immunotherapy and molecular subtypes. Current Opinion in Oncology, 37 (1). pp. 27-34. ISSN 1040-8746

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Abstract

Purpose of review Recent findings Summary Small cell lung cancer (SCLC) is an aggressive disease with a poor prognosis, whereas its metastatic capacity carries a predilection for the brain. Although prophylactic cranial irradiation (PCI) has been used to address this problem, upcoming alternatives might necessitate reflection of its application in SCLC treatment. The addition of immunotherapy to treatment guidelines has provided a new strategy for the management of brain metastases. Complementation of immunotherapy with active MRI surveillance could potentially replace PCI and avoid irradiation-related cognitive side effects. SCLC’s molecular profile is heterogeneous, with differential response to treatment modalities between subgroups. Investigation of these variances might be essential to improve therapeutic outcomes in SCLC patients. The role of PCI in SCLC treatment must be examined in light of immunotherapy. We summarize recent results, bearing SCLC subtypes and therapeutic vulnerabilities in mind, to derive tailored treatment strategies for SCLC patients in future settings.

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