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Integration of immunotherapy with chemotherapy (immunochemotherapy, IO+CT) has improved progression-free survival and overall survival versus CT alone, but biomarker guidance for ES-SCLC remains insufficient. Baseline liver metastases are emphasized as a key independent risk factor, potentially reflecting an immunosuppressive “cold” liver tumor immune microenvironment that can blunt immunotherapy effectiveness.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/a-challenge-for-treating-patients-with-extensive-stage-small-cell-lung-cancers-particularly-for-those-with-liver-metastases/433738/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/a-challenge-for-treating-patients-with-extensive-stage-small-cell-lung-cancers-particularly-for-those-with-liver-metastases/433738.png","ImageObject",300,407,{"name":92,"@type":93},"Hazel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is ES-SCLC considered particularly challenging to treat?","Question",{"text":113,"@type":114},"ES-SCLC is highly aggressive, progresses rapidly, and commonly spreads to vital organs, leading to historically poor outcomes with standard dual-drug chemotherapy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does immunochemotherapy (IO+CT) change outcomes compared with chemotherapy alone?",{"text":118,"@type":114},"IO+CT improves progression-free survival and overall survival versus CT alone, including a reported increase in OS relative to the historical benchmark.",{"name":120,"@type":111,"acceptedAnswer":121},"What role do baseline liver metastases play in ES-SCLC prognosis and immunotherapy response?",{"text":122,"@type":114},"Baseline liver metastases are highlighted as a major independent risk factor for worse outcomes, and the liver’s immunosuppressive immune microenvironment may reduce immunotherapy efficacy.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433738,1790817722,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},137441390410,"https://ap-avatar.wpscdn.com/avatar/2000252f4ab5702993?_k=1776741390130283984","J Chin MedAssoc  \nEditorial  \nA challenge for treating patients with extensivestage small cell lung cancers, particularly for those with liver metastases  \nPeng-Hui Wanga,b,c,*  \naDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; bInstitute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cFemale Cancer Foundation, Taipei, Taiwan, ROC  \nSmall cell lung cancer (SCLC) accounts for approximately 10% to 15% of all lung cancers (LC), but it is associated with an extremely poor prognosis, particularly for extensive-stage SCLC patients (ES-SCLC) with a stagnant 5-year overall survival (OS)\u003C10% .1 Compared to other non-SCLC, SCLC is a biologically highly aggressive LC characterized by rapid disease evolution, widespread metastases, and dissemination to other vital organs, and it is estimated that over 70% of SCLC patients are in the extensive stage.1–4 Based on its vulnerability to vital-organ metastases, such as liver and brain metastases, and once ES-SCLC is diagnosed, therapeutic challenges arise. Conventional dualdrug chemotherapy (CT) regimen (etoposide-platinum: EP regimen) alone has produced acceptable short-term responses (60%-80%, including 43% of complete response)1; unfortunately, almost all ES-SCLC patients progress and result in the historical OS benchmark hovering between 8 and 10 months,1 which is also confirmed by recent Taiwan domestic data with 8.5-month OS in their cohort study.5 Recently, due to an integration of immunotherapy (IO) into the CT, called immunochemotherapy (IO+CT),6 the historical dismal outcomes of these cancers have been reversed, and compared to CT alone, have shown significantly improved outcomes in patients (prolongation of progression-free survival [PFS] and OS), which include non-SCLC,4 SCLC,5 gastric cancer,7–9 neuroendocrine cancer,10 cervical cancer,11–13 ovarian cancer,14 endometrial cancer,15,16 and many others.13  \nAccording to the dismal outcomes of patients with ES-SCLC treated by CT alone, Dr. Liao’s group using IO-CT for treating ES-SCLC patients is worthy of. This study was published published in the August 2025 issue of the Journal of Chinese Medical Association (JCMA) .5 Dr. Liao reported 33 women with ES-SCLC undergoing the first-line (1L) IO+CT (immune checkpoint inhibitors [ICIs] as a backbone of IO) to investigate the therapeutic effectiveness, and found that, although PFS in the IO+CT group did not reach the statistically significant difference compared to CT alone group (median PFS: 5.0 vs 4.8  \n*Address correspondence. Dr. Peng-Hui Wang, Department of Obstetricsand Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail addresses: phwang@vghtpe.gov.tw](ROC. E-mail addresses: phwang@vghtpe.gov.tw); [pongpongwang@gmail.com](pongpongwang@gmail.com) (P.-H. Wang).  \nConflicts of interest: Dr. Peng-Hui Wang, an editorial board member at the Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article.  \nJournal of Chinese Medical Association. (2025) 88: 904-905.  \nReceived October 7, 2025; accepted October 9, 2025. doi: 10. 1097/JCMA.0000000000001310  \nCopyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nmonths), OS in the IO+CT group was significantly increased by 5.4 months compared with the CT alone group (from historical 8.5-month OS to 13.9-month OS),5 suggesting that IO+CT therapy should be applied as standard of care (SOC) therapy for all ES-SCLC patients. However, unlike gynecologic cancers with clear biomarker-guided agonistic therapy (a benefit of integration of IO into CT based on programmed death protein ligand 1 [PD-L1] expression pattern of the cervical cancer [immuno","cbCaitiADacaKWuw","https://ap.wps.com/l/cbCaitiADacaKWuw","pdf",292454,"English","# Editorial\n## Background and therapeutic challenge\n## Shift from CT to IO+CT outcomes\n## Biomarker limitations in ES-SCLC\n## Prognostic role of liver metastases\n## Need for overcoming resistance","[{\"question\":\"Why is ES-SCLC considered particularly challenging to treat?\",\"answer\":\"ES-SCLC is highly aggressive, progresses rapidly, and commonly spreads to vital organs, leading to historically poor outcomes with standard dual-drug chemotherapy.\"},{\"question\":\"How does immunochemotherapy (IO+CT) change outcomes compared with chemotherapy alone?\",\"answer\":\"IO+CT improves progression-free survival and overall survival versus CT alone, including a reported increase in OS relative to the historical benchmark.\"},{\"question\":\"What role do baseline liver metastases play in ES-SCLC prognosis and immunotherapy response?\",\"answer\":\"Baseline liver metastases are highlighted as a major independent risk factor for worse outcomes, and the liver’s immunosuppressive immune microenvironment may reduce immunotherapy efficacy.\"}]","A challenge for treating patients with extensive-stage small cell lung cancers, particularly for those with liver metastases | PDF",1790665337]