Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Carboplatin-etoposide with atezolizumab or durvalumab in small cell lung cancer

The IMpower133 and CASPIAN regimens for extensive-stage disease

Updated: 28 October 20261 min read4 references

Summary for doctors

  • First line in extensive-stage small cell lung cancer [1, 2].
  • 4 cycles of chemoimmunotherapy, then maintenance immunotherapy [1, 2].
  • A modest but durable absolute benefit; some patients live for years.

Dose and schedule

Carbo/Etop + atezolizumab

Extensive-stage small cell lung cancerCycle length: Every 21 days

Extensive-stage small cell lung cancer

DrugDoseRouteSchedule
Phase 1: 4 cycles
CarboplatinAUC 5IVDay 1
Etoposide100 mg/m²IVDays 1 to 3
Atezolizumab1200 mgIVDay 1
Phase 2
Atezolizumab1200 mgIVEvery 21 days
Cycle length
Every 21 days
Duration
Atezolizumab until progression

Doses as in IMpower133 [1].

Dose source: [3].

Evidence: IMpower133 (2018)

Platinum/Etop + durvalumab

Extensive-stage small cell lung cancer

Extensive-stage small cell lung cancer

DrugDoseRouteSchedule
Phase 1: 4 cycles
Carboplatin (or cisplatin 75 to 80 mg/m²)AUC 5 to 6IVDay 1
Etoposide80 to 100 mg/m²IVDays 1 to 3
Durvalumab1500 mgIVDay 1
Phase 2
Durvalumab1500 mgIVEvery 28 days
Cycle length
Chemotherapy every 21 days; maintenance durvalumab every 28 days
Duration
Durvalumab until progression

Doses as in CASPIAN [2].

Dose source: [4].

Evidence: CASPIAN (2019)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Antiemetics: carboplatin AUC 5 or more: NK1, 5-HT3 and dexamethasone.
  • Prophylactic cranial irradiation or MRI surveillance, as decided by the team.

Monitoring and dose adjustment

  • Blood counts before each cycle; hyponatraemia (SIADH) is common; TSH, glucose, liver enzymes and creatinine at baseline and every 6 weeks; immune-related toxicity as in the immunotherapy toxicity lesson.

Main evidence

Show detailsHide

IMpower133: median survival 12.3 vs 10.3 months [1]. CASPIAN: median survival 13.0 vs 10.3 months [2].

Related cancer types

Lung cancer

Treatment regimens (physicians)

Trastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoringCarboplatin, pemetrexed and pembrolizumab (KEYNOTE-189)Carboplatin, paclitaxel and pembrolizumab (KEYNOTE-407)Durvalumab after chemoradiotherapy in stage 3 lung cancer (PACIFIC)Pembrolizumab alone in lung cancer with high PD-L1 (KEYNOTE-024)Osimertinib with pemetrexed and platinum (FLAURA2)Amivantamab with lazertinib (MARIPOSA)Adjuvant alectinib after surgery for ALK-positive lung cancer (ALINA)

Physician tools and lessons

Khorana Score (Cancer-Associated Thrombosis Risk)Should I Be Screened for Lung Cancer? (Pack-Year Calculator)10 cheap steps that save patients' livesManagement of brain metastasesMalignant pleural effusion: drainage, pleurodesis or an indwelling catheter

References

4 references
Show all references, 2 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung CancerHorn L, Mansfield AS, Szczęsna A, et al · N Engl J Med · 2018;379:2220-2229
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trialPaz-Ares L, Dvorkin M, Chen Y, et al · Lancet · 2019;394:1929-1939
    Study cardDOIPubMed Back to text: 1 2 3 4
  3. 3
    TECENTRIQ (ATEZOLIZUMAB) — Prescribing InformationGenentech, Inc · FDA label · 2026
    Source Back to text
  4. 4
    IMFINZI (DURVALUMAB) — Prescribing InformationAstrazeneca Pharmaceuticals LP · FDA label · 2026
    Source Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/carboplatin-etoposide-immunotherapy-sclc/

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