Integration of ımmunotherapy in limited-stage small cell lung cancer: a review of the literature.

This review focuses on integrating immunotherapy into the management of limited-stage small cell lung cancer (LS-SCLC), a disease marked by aggressive biology and early relapse despite standard concurrent chemoradiotherapy and prophylactic cranial irradiation.

Key points:

• Rationale and biology: The authors outline the immunogenic nature of SCLC and the success of immune checkpoint inhibitors in extensive-stage disease as the basis for testing immunotherapy in LS-SCLC across different treatment time points (neoadjuvant, concurrent, and consolidation).

• Neoadjuvant immunotherapy: Early-phase (mostly phase II and retrospective) studies of immunotherapy before definitive chemoradiation show encouraging response rates but are limited by small sample sizes and lack of randomized data. The approach is considered promising but still exploratory.

• Concurrent chemoradiotherapy plus immunotherapy: Trials combining immunotherapy with chemoradiation have produced inconsistent and heterogeneous results. The review concludes that larger, advanced-phase randomized studies are required before this strategy can be considered standard, particularly to clarify safety and efficacy.

• Consolidation immunotherapy: Evidence is strongest for consolidation treatment after completion of concurrent chemoradiotherapy. Data from the ADRIATIC trial demonstrate a clinically meaningful benefit with consolidation durvalumab, supporting its adoption as a new standard of care in LS-SCLC following chemoradiation.

• Biomarkers and patient selection: Reliable biomarkers to predict benefit from neoadjuvant, concurrent, or consolidation immunotherapy are not yet established. The review emphasizes the need to define which patient subgroups gain the most from immunotherapy and to develop predictive tools beyond current clinical criteria.

• Future directions: The authors call for large, prospective trials to optimize timing (neoadjuvant vs concurrent vs consolidation), refine patient selection, clarify long-term safety, and integrate biomarker-driven strategies into LS-SCLC treatment algorithms.