he standard treatment regimen for small cell lung cancer (SCLC) relies on platinum-based systemic chemotherapy. However, its high toxicity and limited long-term efficacy have driven clinical researchers to explore chemotherapy-free or de-chemotherapy strategies. This case reports an elderly patient with limited-stage SCLC who achieved sustained partial response (PR) without receiving systemic chemotherapy. The patient underwent staged hypofractionated radiotherapy combined with immunotherapy (sintilimab) and targeted therapy (surufatinib), resulting in a disease-free survival of 11 months without significant toxic side effects. This case highlights the potential advantages of a chemotherapy-free approach in SCLC treatment and provides valuable clinical insights into optimizing therapeutic strategies for enhanced efficacy with reduced toxicity.

1.Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12-49. DOI: 10.3322/caac.21820.

2.Asai N, Ohkuni Y, Kaneko N, et al. Relapsed small cell lung cancer: treatment options and latest developments[J]. Ther Adv Med Oncol, 2014, 6(2): 69-82. DOI: 10.1177/ 1758834013517413.

3.Gomez-Randulfe I, Leporati R, Gupta B, et al. Recent advances and future strategies in first-line treatment of ES-SCLC[J]. Eur J Cancer, 2024, 200: 113581. DOI: 10.1016/j.ejca.2024.113581.

4.Roth BJ, Johnson DH, Einhorn LH, et al. Randomized study of cyclophosphamide, doxorubicin, and vincristine versus etoposide and cisplatin versus alternation of these two regimens in extensive small-cell lung cancer: a phase III trial of the southeastern cancer study group[J]. J Clin Oncol, 1992, 10(2): 282-291. DOI: 10.1200/JCO.1992.10.2.282.

5.Caliman E, Fancelli S, Petroni G, et al. Challenges in the treatment of small cell lung cancer in the era of immunotherapy and molecular classification[J]. Lung Cancer, 2023, 175: 88-100. DOI: 10.1016/j.lungcan.2022.11.014.

6.Puri S, Lok BH, Leighl N, et al. Editorial: update on the biology, management, and treatment of small cell lung cancer[J]. Front Oncol, 2020, 10: 1783. DOI: 10.3389/fonc.2020.01783.

7.Yang CFJ, Chan DY, Shah SA, et al. Long-term survival after surgery compared with concurrent chemoradiation for node-negative small cell lung cancer[J]. Ann Surg, 2018, 268(6): 1105-1112. DOI: 10.1097/SLA.0000000000002287.

8.Paz-Ares L, Chen Y, Reinmuth N, et al. Durvalumab, with or without tremelimumab, plus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer: 3-year overall survival update from CASPIAN[J]. ESMO Open, 2022, 7(2): 100408. DOI: 10.1016/j.esmoop.2022.100408.

9.Horn L, Mansfield AS, Szczęsna A, et al. First-line atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer[J]. N Engl J Med, 2018, 379(23): 2220-2229. DOI: 10.1056/NEJMoa1809064.

10.Wang J, Zhou C, Yao W, et al. Adebrelimab or placebo plus carboplatin and etoposide as first-line treatment for extensive-stage small-cell lung cancer (CAPSTONE-1): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet Oncol, 2022, 23(6): 739-747. DOI: 10.1016/S1470-2045(22)00224-8.

11.Cheng Y, Han L, Wu L, et al. Effect of first-line serplulimab vs placebo added to chemotherapy on survival in patients with extensive-stage small cell lung cancer: the ASTRUM-005 randomized clinical trial[J]. JAMA, 2022, 328(12): 1223. DOI: 10.1001/jama.2022.16464.

12.Turrisi AT, Kim K, Blum R, et al. Twice-daily compared with once-daily thoracic radiotherapy in limited small-cell lung cancer treated concurrently with cisplatin and etoposide[J]. N Engl J Med, 1999, 340(4): 265-271. DOI: 10.1056/NEJM199901283400403.

13.Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial[J]. Lancet Oncol, 2017, 18(8): 1116-1125. DOI: 10.1016/S1470-2045(17)30318-2.

14.Bogart J, Wang X, Masters G, et al. High-dose once-daily thoracic radiotherapy in limited-stage small-cell lung cancer: CALGB 30610 (Alliance)/RTOG 0538[J]. J Clin Oncol, 2023, 41(13): 2394-2402. DOI: 10.1200/JCO.22.01359.

15.Hu X, Sun ZH, Chen MY, et al. EP13.04-04 preliminary results of a prospective trial of hypofractionated radiotherapy versus hyperfractionated radiotherapy for limited-stage SCLC[J]. J Thorac Oncol, 2023, 18(11): S699-S700. DOI: 10.1016/j.jtho.2023.09.1347.

16.Bi N, Zhang T, Hu X, et al. MA18.03 preliminary safety and treatment data of a phase 3 trial: hypofractionated vs. conventional fractionated concurrent chemoradiation for LS-SCLC[J]. J Thorac Oncol, 2023, 18(11): S166. DOI: 10.1016/j.jtho.2023.09.245.

17.Wang NH, Lei Z, Yang HN, et al. Radiation-induced PD- L1 expression in tumor and its microenvironment facilitates cancer- immune escape: a narrative review[J]. Ann Transl Med, 2022, 10(24): 1406. DOI: 10.21037/atm-22-6049.

18.Syed YY. Surufatinib: first approval[J]. Drugs, 2021, 81(6): 727-732. DOI: 10.1007/s40265-021-01489-y.

19.Cannarile MA, Weisser M, Jacob W, et al. Colony-stimulating factor 1 receptor (CSF1R) inhibitors in cancer therapy[J]. J Immunother Cancer, 2017, 5(1): 53. DOI: 10.1186/s40425-017-0257-y.

20.Zhang Y, Huang Y, Yang Y, et al. Surufatinib plus toripalimab combined with etoposide and cisplatin as first-line treatment in advanced small-cell lung cancer patients: a phase ib/II trial[J]. Signal Transduct Target Ther, 2024, 9(1): 255. DOI: 10.1038/s41392-024-01974-2.

21.Cheng Y, Spigel DR, Cho BC, et al. Durvalumab after chemoradiotherapy in limited-stage small-cell lung cancer[J]. N Engl J Med, 2024, 391(14): 1313-1327. DOI: 10.1056/NEJMoa2404873.

22.Baine MK, Hsieh MS, Lai WV, et al. SCLC subtypes defined by ASCL1, NEUROD1, POU2F3, and YAP1: a comprehensive immunohistochemical and histopathologic characterization[J]. J Thorac Oncol, 2020, 15(12): 1823-1835. DOI: 10.1016/j.jtho.2020.09.009.