A Paradigm Shift in First-Line Treatment Can Have Many Implications For Second-Line Treatment

I was born in the year of the fall of the Berlin Wall and became a respiratory physician in Japan in 2016. In 2016, a paradigm shift occurred in NSCLC treatment when the use of immune checkpoint inhibitors (ICIs) became covered by insurance in Japan. Subsequently, ICIs became available for first-line treatment of SCLC. There has been a paradigm shift in the treatment of SCLC, raising several clinical questions regarding second-line therapy. With great therapies come great changes and questions. Reconsidering the Cutoff Value for Sensitive and Refractory Relapses in Extensive-Stage SCLC in the Era of ImmunotherapyJournal of Thoracic OncologyVol. 19Issue 2PreviewTraditionally, relapsed SCLC has been classified as "sensitive" or "refractory" on the basis of cutoff values (60 or 90 d) for the duration between the last chemotherapy and disease progression. Nevertheless, these cutoff values are not derived from rigorous analytical methods, and their applicability to contemporary treatments remains uncertain. Full-Text PDF Open AccessA Response to the Letter to the Editor: "A Paradigm Shift in First-Line Treatment Can Have Many Implications for Second-Line Treatment"Journal of Thoracic OncologyVol. 19Issue 2PreviewWe thank Dr. Nishimura for his thought-provoking letter regarding our study and appreciate this opportunity to respond. In our study,1 we refined the formerly ambiguous cutoff for classifying relapsed SCLC to better incorporate modern treatment approaches. We found that the optimal relapse cutoff has shifted from 59 to 75 days with the advent of immunotherapy. The proposed cutoff (75 d) is suitable for application in clinical practice and in future clinical research. Full-Text PDF