Durable, exceptional response to temozolomide in a patient with extensive-stage small cell lung cancer (ES-SCLC) metastatic to brain

Small cell lung cancer (SCLC) is an aggressive tumor that is frequently metastatic at diagnosis. Unfortunately, the repertoire of agents available to clinicians tasked with treating relapsed or refractory extensive-stage SCLC (ES-SCLC) is limited. We report the case of a patient with extensive, relapsed brain metastases who had an exceptional initial response to temozolomide (TMZ). We describe also the ongoing, durable complete radiographic response in excess of four years achieved via a combination of long-term therapy with TMZ and selectively deployed stereotactic radiosurgery (SRS). In spite of its recent addition to the National Comprehensive Cancer Network (NCCN) guidelines for relapsed SCLC, TMZ remains underutilized for this indication. This case supports the off-label use of TMZ in relapsed SCLC, especially those with central nervous system (CNS) metastases-for whom there are few to no available treatment options.