title: Optimal drugs for second-line treatment of patients with small-cell lung cancer.
abstract: BACKGROUND
  Despite the high response rate to chemotherapy, there have been few advances in the treatment of small-cell lung cancer (SCLC) in the last decades. The state-of-the-art second-line therapy and future research developments in relapsed SCLC are reviewed.
  
  
  METHODS
  There are no optimal drugs for second-line treatment of recurrent SCLC but only agents registered for this use. Topotecan remains the standard-of-care for the treatment of second-line platinum-sensitive SCLC patients worldwide, while amrubicin is another option, but registered only in Japan. To date, no targeted agents reporting interesting results in second-line SCLC treatment are available. The next-generation DNA sequencing should discover somatic gene alterations and their roles in SCLC to help in selecting patients who could benefit from a targeted agent. Two immunotherapeutics, ipilimumab and nivolumab, have shown promising preliminary results and are being investigated in ongoing trials.
  
  
  CONCLUSIONS
  Second-line treatment is not an option for most SCLC patients. Given the evidence up to now, the potentials for immuno-oncology in SCLC are high. The hope is that these expectations are met, and that all drugs being developed will offer new and improved treatment options for SCLC patients.
authors.affiliation: a Division of Medical Oncology , 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rossi
authors.affiliation: a Division of Medical Oncology , 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Paola Claudia
authors.initials: PC
authors.lastname: Sacco
authors.affiliation: b Department of Clinical and Experimental Medicine , Second University of Naples , Naples , Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Sgambato
authors.affiliation: b Department of Clinical and Experimental Medicine , Second University of Naples , Naples , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Casaluce
authors.affiliation: a Division of Medical Oncology , 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santabarbara
authors.affiliation: c Division of Medical Oncology , USLL5 , Cittadella (Pd) , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Palazzolo
authors.affiliation: a Division of Medical Oncology , 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Maione
authors.affiliation: a Division of Medical Oncology , 'S.G. Moscati' Hospital , Avellino , Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Gridelli
mesh_terms: D018943:Anthracyclines / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D007167:Immunotherapy; D000074324:Ipilimumab; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000276:immunology; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000276:immunology; D000077594:Nivolumab; D016032:Randomized Controlled Trials as Topic; D055752:Small Cell Lung Carcinoma / Q000188:drug therapy* / Q000276:immunology; D019772:Topotecan / Q000627:therapeutic use
chemical_list: D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000074324:Ipilimumab; D000077594:Nivolumab; D019772:Topotecan; C055866:amrubicin
keywords: Amrubicin; SCLC; chemotherapy; immunotherapy; ipilimumab; nivolumab; targeted therapy; topotecan