关键词：肺肿瘤;小细胞肺癌;免疫治疗;免疫检查点抑制剂;专家共识

共识意见1：推荐程序性死亡受体1（programmedcell death-1 ，PD-1）/ 程 序 性 死 亡 受 体 配 体 1 （programmed cell death-ligand 1，PD-L1）抑制剂联合铂类化疗作为一线治疗ES-SCLC的标准治疗方案，免疫药物包括阿替利珠单抗、度伐利尤单抗、 阿得贝利单抗、斯鲁利单抗、特瑞普利单抗、替雷利珠单抗（证据等级：高，推荐强度：强推荐）。

共识意见2：推荐贝莫苏拜单抗联合安罗替尼及铂类化疗作为一线治疗ES-SCLC的标准治疗方案（证据等级：高，推荐强度：强推荐）。

共识意见：推荐符合标准的 ES-SCLC 患者参加免疫一线治疗联合胸部放疗的临床试验（证据等级：低，推荐强度：弱推荐）。

共识意见1：推荐同步放化疗后无进展的LS-SCLC患者，使用度伐利尤单抗巩固治疗，治疗时间为2年（证据等级：高，推荐强度：强推荐）。

共识意见2：推荐符合标准的LS-SCLC患者参加从诱导治疗开始免疫治疗的临床试验（证据等级：低，推荐强度：弱推荐）。

共识意见3：推荐接受度伐利尤单抗巩固治疗的LS-SCLC 患者进行预防脑照射（prophylacticcranial irradiation，PCI）治疗（证据等级：中，推荐强度：强推荐）。

共识意见1：推荐塔拉妥单抗作为复发 SCLC 的治疗选择（证据等级：中，推荐强度：弱推荐）。

共识意见 2：推荐符合标准的 SCLC 患者加入靶向 Delta 样蛋白 3（delta-like protein 3，DLL3）的双特异性T细胞连接器（bispecific T cell engagers，BiTEs）、双抗、BTLA抑制剂等新药的临床试验（证据等级：低，推荐强度：弱推荐）。

共识意见1：推荐脑转移患者依据是否有症状进行治疗，如果无中枢系统症状，可以先行化疗±免疫等全身治疗，之后行颅脑放疗；如果有中枢系统症状，则应先行颅脑放疗，症状稳定后再开始全身治疗（证据等级：低，推荐强度：弱推荐）。

共识意见2：推荐肝转移患者接受免疫联合化疗或者贝莫苏拜单抗联合安罗替尼和化疗治疗（证据等级：低，推荐强度：弱推荐）。

共识意见3：推荐PS 2分或因疾病导致的PS 3～4 分的患者，在充分知情同意基础上，使用PD-1/PD-L1 抑制剂联合化疗；非SCLC 疾病导致的PS 评分较差的患者，在对症治疗后，症状缓解，一般情况改善 ，可以重新评估是否接受 PD-1/ PD-L1 抑制剂联合化疗（证据等级：低，推荐强度：弱推荐）。

共识意见4：推荐年龄 ≥65 岁的老年人 ES-SCLC 患者，在治疗前进行全面的体能状态评估，体能状态好的患者接受免疫联合EC方案治疗（证据等级：低，推荐强度：弱推荐）。

共识意见5：推荐转化性 SCLC 患者尝试PD-1/PD-L1 抑制剂联合治疗（证据等级：低，推荐强度：弱推荐）。

共识意见：推荐SCLC患者参加探索疗效预测标志物的研究，为标志物指导的SCLC免疫治疗提供依据（证据等级：低，推荐强度：弱推荐）。

ABSTRACT

Lung cancer is one of the malignant tumors with high morbidity and mortality worldwide. Small cell lung cancer (SCLC) is a highly aggressive neuroendocrine tumor that is closely associated with tobacco exposure, accounting for 13% to 15% of all lung cancer cases. It is characterized by a high proliferation rate and exceptional metastatic capacity. At the time of diagnosis, approximately 70% of the patients have metastasized and are classified as extensive-stage small cell lung cancer (ES-SCLC). From 1980 to 2018, chemotherapy and radiotherapy were the main treatment strategies for SCLC. Etoposide combined with platinum has remained the standard first-line treatment for ES-SCLC. Although SCLC is very sensitive to initial treatment, the majority of patients have disease progression within 6 months, and treatment options after recurrence are very limited, and the median survival time is only about 8-10 months. The advent of immune checkpoint inhibitors (ICIs), particularly programmed death-ligand 1 (PD-L1) and programmed death -1 (PD-1) inhibitors, has brought new hope to patients with SCLC. PD-1/PD-L1 plus chemotherapy have significantly prolonged overall survival of patients with ES-SCLC, which has become the new standard of first-line treatment for ES-SCLC. Currently, a raised number of immune checkpoint inhibitors (ICIs) have been approved in China for the treatment of SCLC, providing more treatment options for SCLC patients. To further standardize the clinical practice of SCLC immunotherapy, the "Expert consensus on immunotherapy for SCLC (2025 edition)" has been developed based on domestic and international guidelines, consensus, and relevant medical evidence, aiming to provide reference and guidance for domestic clinicians.

来源：中华肿瘤杂志

编辑：Dakota Zhu