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It contrasts the historical EP doublet chemotherapy benchmark with short duration of response and unmet clinical needs. It highlights emerging biomarker- and genome-guided therapies while emphasizing the need to balance maximal efficacy against safety and treatment-related adverse events. The editorial summarizes Liao’s August 2025 JCMA study comparing immunochemotherapy plus first-line care versus standard chemotherapy and outlines prognostic and treatment-related predictors.",{"@graph":69,"@context":122},[70,84,105],{"@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/optimizing-outcomes-for-the-patients-with-extensive-stage-small-cell-lung-cancer-editorial/433648/",{"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/optimizing-outcomes-for-the-patients-with-extensive-stage-small-cell-lung-cancer-editorial/433648.png","ImageObject",300,407,{"name":92,"@type":93},"Lucas Martin","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why are outcomes for extensive-stage small-cell lung cancer considered very poor?","Question",{"text":112,"@type":113},"ES-SCLC is highly aggressive with early metastases and rapid dissemination, often leading to late diagnosis. Historical doublet chemotherapy yields responses but with very short duration and eventual resistance, keeping long-term survival around 8–10 months.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did immunochemotherapy compare with standard chemotherapy in the cited study?",{"text":117,"@type":113},"Progression-free survival was not significantly different between groups (median 5.0 vs 4.8 months). Overall survival was significantly better with immunochemotherapy (median 13.9 vs 8.5 months; p = 0.003).",{"name":119,"@type":110,"acceptedAnswer":120},"Which prognostic factors and safety-related predictors were highlighted?",{"text":121,"@type":113},"Baseline liver metastasis was associated with both PFS and OS. Consolidative thoracic radiotherapy improved PFS, while grade ≥3 hematologic adverse events and higher neutrophil-to-lymphocyte ratio (NLR ≥ 4) predicted worse overall survival.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},433648,1790792611,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":66,"faqs":140,"seo_title":141,"seo_description":67,"update_tm":142,"read_time":39,"preview_page_count":4},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","J Chin MedAssoc  \nEditorial  \nOptimizing outcomes for the patients with extensive-stage small-cell lung cancer  \nPeng-Hui Wanga,b,c,*, Szu-Ting Yanga,b, Kuan-Chong Chaob,d  \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; dDepartment of Obstetrics and Gynecology, Central Clinic & Hospital, Taipei, Taiwan, ROC  \nLung cancer compared with non-small cell lung cancer (SCLC) is a very aggressive subtype of lung cancers, compared to other non-SCLC,1–3 partly because of its biologically highly invasive characteristics accompanied with rapid disease evolution, early metastases, and prompt dissemination, and partly because of absence of effective screening methods, resulting in late diagnosis, contributing to over two-thirds of SCLC presenting as extensive-stage SCLC (ES-SCLC) with very dismally the worst outcomes (a stagnant 5-year survival plateau at 7%),4 eventhough SCLC represents a relatively rare type of lung cancers, accounting for only 10% to 15% of all lung cancers.4 Unlike treatment for non-SCLC patients, therapeutic strategies based on a doublet chemotherapy regimen (etoposide-platinum [EP] regimen), with acceptable responses (60%-80%, including a 43% complete response rate); however the duration of response (DOR) is very short, and almost all ES-SCLC cases progress due to the development of resistance, limiting the long-term clinical benefits, resulting in the historical survival benchmark hovering between 8 and 10 months.4 Recent JCMA data in resected NSCLC also highlights the need for stratified prognostic approaches.5 All indicate that the therapy for ES-SCLC is suboptimal, and clinical needs are still unmet. Recently, with advanced technology and better understanding of genomic and molecular biology of cancers,6–11 many biomarker-guided agonist therapies have been continuously developed, and many of them have been well investigated for their safety and efficacy by many prospective, randomized clinical trials (RCTs) as well as reviewed by clinical practice and real-world experience.12–15 To reach the maximal benefit-to-risk ratio, many obstacles should be overcome. For example, oncologic safety (the maximal therapeutic efficacy) is always the priority before the conduction of any changes in place of the established standard of care (SOC) therapy.16 Additionally, therapy-related adverse events (AEs) are always kept in mind, particularly for those patients who obtained only marginal benefits of therapeutic efficacy but should pay many treatment-related AEs or therapy-related life-threatening  \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. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2025): 810-812.  \nReceived August 11, 2025; accepted August 12, 2025. doi: 10. 1097/JCMA.0000000000001293  \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/))  \nsituations, which are relatively difficult to manage. Therefore, any recommendation of using the aforementioned type of treatment strategy is always in doubt and of concern.17  \nBased on the","cbCaiquc5HS7KD4D","https://ap.wps.com/l/cbCaiquc5HS7KD4D","pdf",316156,"English","[{\"question\":\"Why are outcomes for extensive-stage small-cell lung cancer considered very poor?\",\"answer\":\"ES-SCLC is highly aggressive with early metastases and rapid dissemination, often leading to late diagnosis. Historical doublet chemotherapy yields responses but with very short duration and eventual resistance, keeping long-term survival around 8–10 months.\"},{\"question\":\"How did immunochemotherapy compare with standard chemotherapy in the cited study?\",\"answer\":\"Progression-free survival was not significantly different between groups (median 5.0 vs 4.8 months). Overall survival was significantly better with immunochemotherapy (median 13.9 vs 8.5 months; p = 0.003).\"},{\"question\":\"Which prognostic factors and safety-related predictors were highlighted?\",\"answer\":\"Baseline liver metastasis was associated with both PFS and OS. Consolidative thoracic radiotherapy improved PFS, while grade ≥3 hematologic adverse events and higher neutrophil-to-lymphocyte ratio (NLR ≥ 4) predicted worse overall survival.\"}]","Optimizing outcomes for the patients with extensive-stage small-cell lung cancer - Editorial | PDF",1790664969]